Prevention of medication errors: teaching and training

Abstract

1. Poor prescribing is probably the most common cause of preventable medication errors in hospitals, and many of these events involve junior doctors who have recently graduated. Prescribing is a complex skill that depends on a sound knowledge of medicines, an understanding of the principles of clinical pharmacology, the ability to make judgements concerning risks and benefits, and ideally experience. It is not surprising that errors occur. 2. The challenge of being a prescriber is probably greater now than ever before. Medical education has changed radically in the last 20 years, reflecting concerns about an overburdened curriculum and lack of focus on social sciences. In the UK, these changes have resulted in less teaching in clinical pharmacology and practical prescribing as guaranteed features of undergraduate training and assessment. There has been growing concern, not least from students, that medical school training is not sufficient to prepare them for the pressures of becoming prescribers. Similar concerns are being expressed in other countries. While irrefutable evidence that these changes are related to medication errors identified in practice, there is circumstantial evidence that this is so. 3. Systems analysis of errors suggests that knowledge and training are relevant factors in causation and that focused education improves prescribing performance. We believe that there is already sufficient evidence to support a careful review of how students are trained to become prescribers and how these skills are fostered in the postgraduate years. We provide a list of guiding principles on which training might be based.

Reliability of a point‐based VTE risk assessment tool in the hands of medical residents

“…Several studies have determined that 65% of medical errors were committed by interns and that 35-44% of those errors resulted from knowledge deficits. [36][37][38] In order to best improve adherence to clinical guidelines, strategies that result in changing physician behavior need to be implemented, and can include but are not limited to the ones found in Figure 2. 39 Ideally, teaching centers with computerized order entry should embed the risk assessment process as part of an admission/ transfer order set, with a reminder alert.…”

NCS Report 22: Code of practice for the quality assurance and control for intensity modulated radiotherapy

“…It is of crucial importance that the level of education matches with the tasks to be performed. The relationship between human errors and adequate education has been demonstrated in several articles (146,147). In our list of examples errors related to education and training of staff can result in systematic errors and affect many treatment plans.…”

The competent prescriber: 12 core competencies for safe prescribing

“…12 This emphasises that prescribing is a staged process rather than a single event and is in line with UK prescribing competencies for new medical graduates. 8 These stages are:…”

“…7 Education is one of the most effective methods to prevent medication errors. 6,8,9 The World Health Organization Good Prescribing Guide was found to be useful in improving students' skills in multiple clinical settings. 9 It could serve as a foundation for a targeted prescribing curriculum, although further development in both the teaching and assessment of prescribing is warranted.…”

“…A set of principles have been developed to guide training of both undergraduates and postgraduates in the UK. 8 These include:…”