Objective: To identify and analyse factors underlying intern prescribing errors to inform development of specific medication‐safety interventions. Design: A prospective qualitative study that involved face‐to‐face interviews and human‐factor analysis. Setting: A tertiary referral teaching hospital, Brisbane, Queensland, February–June, 2004. Participants: Fourteen intern prescribers involved in 21 errors. Method: A structured questionnaire was used to identify factors causing the errors. Transcripts were analysed on the basis of human‐error theory to identify underlying themes. Main outcome measures: Factors underlying prescribing errors. Results: Errors were multifactorial, with a median of 4 (range, 2–5) different types of performance‐influencing factors per error. Lack of drug knowledge was not the single causative factor in any incident. The factors in new‐prescribing errors included team, individual, patient and task factors. Factors associated with errors in represcribing were environment, task and number of weeks into the term. Defences against error, such as other clinicians and guidelines, were porous, and supervision was inadequate or not tailored to the patient, task, intern or environment. Factors were underpinned by an underlying culture in which prescribing is seen as a repetitive low‐risk chore. Conclusion: To reduce the risk of prescribing errors, a range of strategies addressing patient, task, individual, team and environment factors must be introduced.

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Background: The General Level Framework (GLF) is a tool for evaluating pharmacists' performance, providing tailored feedback and training, and guiding professional development. Aim: To ascertain the changes in pharmacists' workplace performance over time using the GLF and to describe pharmacists' views on the baseline evaluation process. Method: The UK GLF was mapped against Australian pharmacy competency standards and practice guidelines. 61 of the 92 competencies from the Queensland Health version of the GLF representing core professional activities of Australian pharmacists were analysed. Trained evaluators used the adapted GLF to observe pharmacists from 18 Queensland public hospitals in their workplace (baseline and repeat) and rate the frequency with which competencies were completed to a defined standard. The evaluators then provided pharmacists with tailored feedback, encouraged self-problem solving, and identified and addressed their training needs. Pharmacists' views of the baseline evaluation process was assessed using a 7-point rating scale. Results: 66 pharmacists from 18 Queensland hospitals underwent the evaluation. At baseline, pharmacists had a median of 3 (1 to 10) years hospital experience. A median of 14 (5 to 22) months lapsed between baseline and repeat observations. Of the 61 competencies analysed, 35 (57%) competencies showed a significant improvement from baseline to repeat observations (p ≤ 0.05). Competencies that improved significantly from baseline included: aspects of medication history taking; medication management; identification, documentation and resolution of drug-related problems; appraisal of therapeutic options; and communication with doctors and nurses. For 9 (15%) competencies, pharmacists were already performing at the maximum level (median score 4) at baseline and no change was recorded between observations. No competency demonstrated a decrease in performance between observations. When the mean scores with 95% confidence intervals for the clusters of competencies were compared over time all the mean scores except for discharge

ObjectivesCurrent evidence to support non-medical prescribing is predominantly qualitative, with little evaluation of accuracy, safety and appropriateness. Our aim was to evaluate a new model of service for the Australia healthcare system, of inpatient medication prescribing by a pharmacist in an elective surgery preadmission clinic (PAC) against usual care, using an endorsed performance framework.DesignSingle centre, randomised controlled, two-arm trial.SettingElective surgery PAC in a Brisbane-based tertiary hospital.Participants400 adults scheduled for elective surgery were randomised to intervention or control.InterventionA pharmacist generated the inpatient medication chart to reflect the patient's regular medication, made a plan for medication perioperatively and prescribed venous thromboembolism (VTE) prophylaxis. In the control arm, the medication chart was generated by the Resident Medical Officers.Outcome measuresPrimary outcome was frequency of omissions and prescribing errors when compared against the medication history. The clinical significance of omissions was also analysed. Secondary outcome was appropriateness of VTE prophylaxis prescribing.ResultsThere were significantly less unintended omissions of medications: 11 of 887 (1.2%) intervention orders compared with 383 of 1217 (31.5%) control (p<0.001). There were significantly less prescribing errors involving selection of drug, dose or frequency: 2 in 857 (0.2%) intervention orders compared with 51 in 807 (6.3%) control (p<0.001). Orders with at least one component of the prescription missing, incorrect or unclear occurred in 208 of 904 (23%) intervention orders and 445 of 1034 (43%) controls (p<0.001). VTE prophylaxis on admission to the ward was appropriate in 93% of intervention patients and 90% controls (p=0.29).ConclusionsMedication charts in the intervention arm contained fewer clinically significant omissions, and prescribing errors, when compared with controls. There was no difference in appropriateness of VTE prophylaxis on admission between the two groups.Trial RegistrationRegistered with ANZCTR—ACTR Number ACTRN12609000426280

Introduction of a standard revised medication chart significantly reduced the frequency of prescribing errors, improved ADR documentation and decreased the potential risks associated with warfarin management. The standard chart has enabled uniform training in medicine management.

Background: Intravenous (IV) fluid administration is an integral component of clinical care. Errors in administration can cause detrimental patient outcomes and increase healthcare costs, although little is known about medication administration errors associated with continuous IV infusions. Objectives: (1) To ascertain the prevalence of medication administration errors for continuous IV infusions and identify the variables that caused them. (2) To quantify the probability of errors by fitting a logistic regression model to the data. Methods: A prospective study was conducted on three surgical wards at a teaching hospital in Australia. All study participants received continuous infusions of IV fluids. Parenteral nutrition and non-electrolyte containing intermittent drug infusions (such as antibiotics) were excluded. Medication administration errors and contributing variables were documented using a direct observational approach. Results: Six hundred and eighty seven observations were made, with 124 (18.0%) having at least one medication administration error. The most common error observed was wrong administration rate. The median deviation from the prescribed rate was 247 ml/h (interquartile range 275 to +33.8 ml/h). Errors were more likely to occur if an IV infusion control device was not used and as the duration of the infusion increased. Conclusions: Administration errors involving continuous IV infusions occur frequently. They could be reduced by more common use of IV infusion control devices and regular checking of administration rates.

Objective. To evaluate the acceptability and validity of an adapted version of the General Level Framework (GLF) as a tool to facilitate and evaluate performance development in general pharmacist practitioners (those with less than 3 years of experience) in a Singapore hospital. Method. Observational evaluations during daily clinical activities were prospectively recorded for 35 pharmacists using the GLF at 2 time points over an average of 9 months. Feedback was provided to the pharmacists and then individualized learning plans were formulated. Results. Pharmacists' mean competency cluster scores improved in all 3 clusters, and significant improvement was seen in all but 8 of the 63 behavioral descriptors ( p # 0.05). Nonsignificant improvements were attributed to the highest level of performance having been attained upon initial evaluation. Feedback indicated that the GLF process was a positive experience, prompting reflection on practice and culminating in needs-based learning and ultimately improved patient care. Conclusions. The General Level Framework was an acceptable tool for the facilitation and evaluation of performance development in general pharmacist practitioners in a Singapore hospital.

ObjectiveTo understand how the formal curriculum experience of an Australian undergraduate pharmacy program supports students’ professional identity formation.MethodsA qualitative ethnographic study was conducted over four weeks using participant observation and examined the ‘typical’ student experience from the perspective of a pharmacist. A one-week period of observation was undertaken with each of the four year groups (that is, for years one to four) comprising the undergraduate curriculum. Data were collected through observation of the formal curriculum experience using field notes, a reflective journal and informal interviews with 38 pharmacy students. Data were analyzed thematically using an a priori analytical framework.ResultsOur findings showed that the observed curriculum was a conventional curricular experience which focused on the provision of technical knowledge and provided some opportunities for practical engagement. There were some opportunities for students to imagine themselves as pharmacists, for example, when the lecture content related to practice or teaching staff described their approach to practice problems. However, there were limited opportunities for students to observe pharmacist role models, experiment with being a pharmacist or evaluate their professional identities. While curricular learning activities were available for students to develop as pharmacists e.g. patient counseling, there was no contact with patients and pharmacist academic staff tended to role model as educators with little evidence of their pharmacist selves.ConclusionsThese findings suggest that the current conventional approach to the curriculum design may not be fully enabling learning experiences which support students in successfully negotiating their professional identities. Instead it appeared to reinforce their identities as students with a naïve understanding of professional practice, making their future transition to professional practice challenging.