Prevalence and causes of prescribing errors

the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study

Cristin Ryan, Sarah Ross, Peter Davey, Eilidh M Duncan, Jill J Francis, Shona Fielding, Marie Johnston, Jean Ker, Amanda J Lee, Mary J MacLeod, Simon Maxwell, Gerard A McKay, James S McLay, David J Webb, Christine Bond

Research output: Contribution to journalArticle

76 Citations (Scopus)
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Abstract

Objectives

Study 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.

Method

A 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.

Results

4710 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.

Conclusions

Prescribing 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.
Original languageEnglish
Article numbere79802
Number of pages9
JournalPloS ONE
Volume9
Issue number1
DOIs
Publication statusPublished - 3 Jan 2014

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physicians
Scotland
Self Efficacy
Causality
Interviews
self-efficacy
working conditions
Consultants
Workload
Teaching Hospitals
Observational Studies
interviews
medicine
Cross-Sectional Studies
Clinical Studies
Prospective Studies
Pressure
consultants
observational studies
cross-sectional studies

Cite this

Prevalence and causes of prescribing errors : the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study. / Ryan, Cristin; Ross, Sarah; Davey, Peter; Duncan, Eilidh M; Francis, Jill J; Fielding, Shona; Johnston, Marie; Ker, Jean; Lee, Amanda J; MacLeod, Mary J; Maxwell, Simon; McKay, Gerard A; McLay, James S; Webb, David J; Bond, Christine.

In: PloS ONE, Vol. 9, No. 1, e79802, 03.01.2014.

Research output: Contribution to journalArticle

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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.",
author = "Cristin Ryan and Sarah Ross and Peter Davey and Duncan, {Eilidh M} and Francis, {Jill J} and Shona Fielding and Marie Johnston and Jean Ker and Lee, {Amanda J} and MacLeod, {Mary J} and Simon Maxwell and McKay, {Gerard A} and McLay, {James S} and Webb, {David J} and Christine Bond",
note = "Acknowledgments We would like to express our gratitude to the pharmacists who collected the data, the doctors who participated in interviews and who completed the questionnaire, and the staff at NES for helping us to deliver this research project. We would also like to thank Directors of Pharmacy and Medical Directors within each participating hospital for supporting the project.",
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AU - Ryan, Cristin

AU - Ross, Sarah

AU - Davey, Peter

AU - Duncan, Eilidh M

AU - Francis, Jill J

AU - Fielding, Shona

AU - Johnston, Marie

AU - Ker, Jean

AU - Lee, Amanda J

AU - MacLeod, Mary J

AU - Maxwell, Simon

AU - McKay, Gerard A

AU - McLay, James S

AU - Webb, David J

AU - Bond, Christine

N1 - Acknowledgments We would like to express our gratitude to the pharmacists who collected the data, the doctors who participated in interviews and who completed the questionnaire, and the staff at NES for helping us to deliver this research project. We would also like to thank Directors of Pharmacy and Medical Directors within each participating hospital for supporting the project.

PY - 2014/1/3

Y1 - 2014/1/3

N2 - 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.

AB - 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.

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JO - PloS ONE

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SN - 1932-6203

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