Where do we go wrong? Prescribing errors by doctors during induction training?

Abstract

Objective To evaluate prescribing errors made during induction training and evaluate these for any common themes. Methods Four basic questions requiring five or six drugs to be prescribed were administered at the end of the Child Health Induction session for junior doctors. These focused on commonly used medications including analgesics and antibiotics. The doctors were given the BNF for Children (BNFC) and were allowed to use calculators. Answers were derived from the BNFC. We analysed errors by the following parameters: Route of administration, Dosage, Frequency and Dated and signed. Results 96 junior doctors participated between August 2007 and December 2009. 537 individual drug prescriptions were analysed revealing 114 errors (21.2%). Type of error Frequency Percentage of errors Dosage 58 50.8 Frequency 18 15.7 Dose and frequency 14 12.2 Not attempted 13 11.4 Dose mentioned as a range 9 7.8 Route of administration 1 0.9 Not dated and/or signed 1 0.9 Total 114 100 The 58 dosage errors included; underdose-47 (antibiotics), overdose-11 (antibiotics-5, analgesics-6). Conclusion Prescribing errors occur frequently in paediatric admissions with a small proportion causing harm.1 Suggestions to reduce medication errors in children include a recommendation that staff should have sufficient training and continuous education in the use of paediatric medications.2 The GMC emphasises the importance of safe prescribing by all doctors.3 Over recent years routine training and evaluation of junior doctors prescribing ability has been performed as part of Child Health induction training in Cardiff. A significant proportion of prescriptions had an error; around two thirds relating to incorrect dosage or frequency. Future teaching will try to target these mistakes. Mandatory prescription training and evaluation seems valuable.