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Learning curves, taking instructions, and patient safety

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Learning curves, taking instructions, and patient safety : using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. / Duncan, Eilidh M; Francis, Jill J; Johnston, Marie; Davey, Peter; Maxwell, Simon; McKay, Gerard A; McLay, James; Ross, Sarah; Ryan, Cristin; Webb, David J; Bond, Christine; PROTECT Study Group.

In: Implementation Science, Vol. 7, 86, 11.09.2012.

Research output: Contribution to journalArticle

Harvard

Duncan, EM, Francis, JJ, Johnston, M, Davey, P, Maxwell, S, McKay, GA, McLay, J, Ross, S, Ryan, C, Webb, DJ, Bond, C & PROTECT Study Group 2012, 'Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors' Implementation Science, vol 7, 86., 10.1186/1748-5908-7-86

APA

Duncan, E. M., Francis, J. J., Johnston, M., Davey, P., Maxwell, S., McKay, G. A., ... PROTECT Study Group (2012). Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implementation Science, 7, [86]. 10.1186/1748-5908-7-86

Vancouver

Duncan EM, Francis JJ, Johnston M, Davey P, Maxwell S, McKay GA et al. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implementation Science. 2012 Sep 11;7. 86. Available from: 10.1186/1748-5908-7-86

Author

Duncan, Eilidh M; Francis, Jill J; Johnston, Marie; Davey, Peter; Maxwell, Simon; McKay, Gerard A; McLay, James; Ross, Sarah; Ryan, Cristin; Webb, David J; Bond, Christine; PROTECT Study Group / Learning curves, taking instructions, and patient safety : using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors.

In: Implementation Science, Vol. 7, 86, 11.09.2012.

Research output: Contribution to journalArticle

Bibtex - Download

@article{e5f46682fba3495784aca7650935b718,
title = "Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors",
keywords = "Patient safety, Junior doctors, prescribing practice",
author = "Duncan, {Eilidh M} and Francis, {Jill J} and Marie Johnston and Peter Davey and Simon Maxwell and McKay, {Gerard A} and James McLay and Sarah Ross and Cristin Ryan and Webb, {David J} and Christine Bond and {PROTECT Study Group}",
year = "2012",
doi = "10.1186/1748-5908-7-86",
volume = "7",
journal = "Implementation Science",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Learning curves, taking instructions, and patient safety

T2 - using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors

A1 - Duncan,Eilidh M

A1 - Francis,Jill J

A1 - Johnston,Marie

A1 - Davey,Peter

A1 - Maxwell,Simon

A1 - McKay,Gerard A

A1 - McLay,James

A1 - Ross,Sarah

A1 - Ryan,Cristin

A1 - Webb,David J

A1 - Bond,Christine

A1 - PROTECT Study Group

AU - Duncan,Eilidh M

AU - Francis,Jill J

AU - Johnston,Marie

AU - Davey,Peter

AU - Maxwell,Simon

AU - McKay,Gerard A

AU - McLay,James

AU - Ross,Sarah

AU - Ryan,Cristin

AU - Webb,David J

AU - Bond,Christine

AU - PROTECT Study Group

PY - 2012/9/11

Y1 - 2012/9/11

N2 - ABSTRACT: BACKGROUND: Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF) to investigate prescribing in the hospital context among a sample of trainee doctors. METHOD: Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. RESULTS: Seven theoretical domains met the criteria of relevance: "social professional role and identity," "environmental context and resources," "social influences," "knowledge," "skills," "memory, attention, and decision making," and "behavioral regulation." From critical appraisal of the interview data, "beliefs about consequences" and "beliefs about capabilities" were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. CONCLUSIONS: In this investigation of hospital-based prescribing, participants' attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains that should also be targeted, despite participants' perceptions that they were not relevant to prescribing errors. These were beliefs about consequences and beliefs about capabilities. Specifically, in the light of the documented high error rate, beliefs that prescribing errors were not likely to have consequences for patients and that trainee doctors are capable of prescribing without error should also be targeted in an intervention. This study is the first to suggest critical appraisal for domain identification and to use interview data to propose theoretical elaborations and interrelationships between domains.

AB - ABSTRACT: BACKGROUND: Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF) to investigate prescribing in the hospital context among a sample of trainee doctors. METHOD: Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing. RESULTS: Seven theoretical domains met the criteria of relevance: "social professional role and identity," "environmental context and resources," "social influences," "knowledge," "skills," "memory, attention, and decision making," and "behavioral regulation." From critical appraisal of the interview data, "beliefs about consequences" and "beliefs about capabilities" were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation. CONCLUSIONS: In this investigation of hospital-based prescribing, participants' attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains that should also be targeted, despite participants' perceptions that they were not relevant to prescribing errors. These were beliefs about consequences and beliefs about capabilities. Specifically, in the light of the documented high error rate, beliefs that prescribing errors were not likely to have consequences for patients and that trainee doctors are capable of prescribing without error should also be targeted in an intervention. This study is the first to suggest critical appraisal for domain identification and to use interview data to propose theoretical elaborations and interrelationships between domains.

KW - Patient safety

KW - Junior doctors

KW - prescribing practice

U2 - 10.1186/1748-5908-7-86

DO - 10.1186/1748-5908-7-86

M1 - Article

JO - Implementation Science

JF - Implementation Science

VL - 7

ER -

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