Prevalence and Causes of Prescribing Errors: The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

Abstract

ObjectivesStudy objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.MethodA three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established.Results4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p<0.001), surgical (p = <0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p<0.001), a greater number of prescribed medicines (p<0.001) and the months December and June (p<0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.ConclusionsPrescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

Do final‐year medical students have sufficient prescribing competencies? A systematic literature review

“…Poor prescribing may result in prescribing errors and adverse drugs reactions, which could adversely affect patient outcomes, leading to hospitalization or even death 2, 3. There is considerable evidence that junior hospital doctors in the first 2 years of practice after graduation make relatively many prescribing errors (8–10% of prescriptions) and are more likely to make these errors than consultants 4, 5, 6. This is particularly worrying as junior doctors write a large proportion (68%) of hospital prescriptions 5.…”

“…lack of standardization) and patient (e.g. polypharmacy) factors 4, 7, 8. A lack of prescribing competencies (i.e.…”

Errores en las recetas médicas y en la preparación de estas en farmacia de pacientes ambulatorios: El caso del Hospital de Nueva Imperial

“…Algunos autores han determinado, además, que la tasa de error oscila entre 3,5 y 11.4% de las dosis administradas, y que un paciente hospitalizado presenta 0,9 errores de medicación diarios 4,9,10 . Cuarenta y dos por ciento de los eventos adversos potencialmente mortales o graves se deben a errores en la prescripción, en donde la tasa de error oscila entre 6,3 y 14,7% de errores en las recetas manuscritas [11][12][13] .…”

Registration at the time of graduation

“…[10][11][12][13][14][15] These are more readily identifi ed because prescribing in the pre-registration year is only permitted in the supervised environment of hospital practice -alternative measures for supervision will be essential if the timing of registration is brought forward.…”