March 22, 2013 by admin
It can be hard to identify why prescribing errors are made, never mind how to avoid those causes: the results of interviews with junior doctors in eight Scottish hospitals who made prescribing errors have now been published, shedding some useful light. Their perception was there were multiple causes for each type of error and the authors categorised the conditions that produce errors as: team, environment, individual, task or patient. The study included 40 prescribers, being interviewed about 100 errors.
Ross S. et al. Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme. BMJ Qual Saf 2013; 22:97-102.
May 9, 2012 by admin
Much press attention was aroused by the publication of a follow up to a 2009 study by the General Medical Council (GMC) that found one in 20 prescriptions contained either a prescribing or a monitoring error, affecting one in eight patients. A ’severe’ error was found in one in 550 prescriptions. The results are interesting, and well summarised here.
The PRACtICe Study sampled records from 15 GP practices and found that nearly one-third of errors involved “incomplete information on the prescription” and that children and people of 75 or over were nearly twice as likely to have an error on their prescriptions as those aged 15-64 years. Underlying causes included factors related to the prescriber (including undergraduate therapeutic training), to the patient, to the team (poor communication was one), to the working environment (time and workload pressures), to the task, to computer systems (generally seen as positive in preventing error but in some cases causing problems) and the interface between primary and secondary care (variation in quality of hospital communication, willingness of GPs to prescribe medicines recommended by specialists). Interestingly, GPs did express concern about what one called the ‘quasi-autonomous role’ of nurses, with GPs being asked to sign prescriptions for patients they had not assessed. The study authors say that this was not one of the highest risks, but they did pick up a small number of errors associated with this practice, and they comment that, “if nurses are to issue prescriptions based on their own clinical assessment practices it would seem most sensible (and in line with current legislation) for them to be qualified as non-medical prescribers”. Training more non-medical prescribers, particularly pharmacists who might be in a good position to manage complicated regimens, is also suggested as a possible way of adjusting GP workload levels.
And were these all ‘GP prescriptions’? Well, of the 6048 prescriptions included in the study, most were issued by GP partners, with a mere 60 being attributed to non-medical prescribers.
January 20, 2010 by admin
Both prescribing and medication errors are common in paediatric inpatients in the UK according to a recent study.
It is therefore important to develop strategies to reduce paediatric medication errors and future research should concentrate on this.
The researchers looked at drug errors in five hospitals in London and found that about 13.2% of the medication orders written contained an error and that medication administration errors were even more common. The error rate could be higher than in adults.
A small number of the errors detected were potentially fatal although most were unlikely to cause serious harm. The wards studied included some in a specialist children’s hospital as well as some in teaching and non-teaching general hospitals. The error rates varied widely between settings and the data do not reveal why this should be so.
December 19, 2009 by admin
After years of indifference and denial about standards of prescribing, a corner has now been turned, according to the British Pharmacological Society (BPS). It says most professionals now agree that standards of prescribing must be improved and sets out plans to do so.
Commenting on the recent report from the GMC, the BPS asks why, when four out of five of its recommendations centred on education, this was not given greater emphasis?
The BPS solutions are:
- Improving education: a national eLearning project with the Department of Health and medical schools; more opportunities for prescribing practice in training; promoting return of pharmacological and other sciences into higher education.
- Setting improved standards and assessing them: medical student prescribing curriculum already agreed and implemented; working now on a national prescribing assessment tool for final-year medical students.
- Providing professional guidance: launched the BPS ‘Principles of Good Prescribing’.
- Fostering collaboration.
- Improving the system: the introduction of a national prescription sheet for use throughout all hospitals; discussion about electronic prescribing, improved decision support and supervisory structures in first years of training.
The introduction of a prescribing assessment would aim to show that agreed standards of competence have been met before graduation.