Why do interns make prescribing errors? A qualitative study

Abstract

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.

Junior doctors’ communication with hospital pharmacists about prescribing: findings from a qualitative interview study

“…In particular, poor communication has been identified as one factor that can affect prescribing errors 2. Studies have already explored communication between doctors and pharmacists in primary care from both professionals’ perspectives,3–6 but there is a lack of research investigating communication between doctors and pharmacists in secondary care,7 particularly from the junior (Foundation Year (FY) 1) doctors' (doctors in their first year of training postgraduation) perspective with whom pharmacists have frequent contact.…”

“…A more recent study found that FY1 doctors were twice as likely to make a prescribing error compared with consultants 15. FY1 doctors have previously said that one-way communication with little discussion and few opportunities for learning contributed to prescribing errors,2 suggesting better communication may reduce prescribing errors and improve medication safety.…”

Impact of a standard medication chart on prescribing errors: a before-and-after audit

“…The writing of the prescription is seen as a low risk chore, undertaken frequently by junior doctors, and orders are often incomplete, ambiguous or illegible. Misinterpretation of instructions results in further medication errors and potentially in ADEs 3 13 15 16 17…”

“…The causes of prescribing errors and ADEs are multifactorial 17. Individual factors include lack of drug and patient knowledge and of prescribing skills 13 15 18.…”

“…Individual interventions include increasing prescribers’ drug knowledge, prescribing skills and ability to tailor the prescription to the individual 1. Appropriate, tailored supervision of junior doctors is required to ensure senior doctors’ prescribing decisions are correctly converted into unambiguous and accurate medication orders 14 17…”