Perceived causes of prescribing errors by junior doctors in hospital inpatients

a study from the PROTECT programme

Sarah Ross, Cristín Ryan, Eilidh M. Duncan, Jillian J. Francis, Marie Johnston, Jean S. Ker, Amanda Jane Lee, Mary Joan Macleod, Simon Maxwell, Gerard McKay, James McLay, David J. Webb, Christine Bond

    Research output: Contribution to journalArticle

    57 Citations (Scopus)

    Abstract

    INTRODUCTION: Prescribing errors are a major cause of patient safety incidents. Understanding the underlying factors is essential in developing interventions to address this problem. This study aimed to investigate the perceived causes of prescribing errors among foundation (junior) doctors in Scotland. METHODS: In eight Scottish hospitals, data on prescribing errors were collected by ward pharmacists over a 14-month period. Foundation doctors responsible for making a prescribing error were interviewed about the perceived causes. Interview transcripts were analysed using content analysis and categorised into themes previously identified under Reason's Model of Accident Causation and Human Error. RESULTS: 40 prescribers were interviewed about 100 specific errors. Multiple perceived causes for all types of error were identified and were categorised into five categories of error-producing conditions, (environment, team, individual, task and patient factors). Work environment was identified as an important aspect by all doctors, especially workload and time pressures. Team factors included multiple individuals and teams involved with a patient, poor communication, poor medicines reconciliation and documentation and following incorrect instructions from other members of the team. A further team factor was the assumption that another member of the team would identify any errors made. The most frequently noted individual factors were lack of personal knowledge and experience. The main task factor identified was poor availability of drug information at admission and the most frequently stated patient factor was complexity. CONCLUSIONS: This study has emphasised the complex nature of prescribing errors, and the wide range of error-producing conditions within hospitals including the work environment, team, task, individual and patient. Further work is now needed to develop and assess interventions that address these possible causes in order to reduce prescribing error rates.
    Original languageEnglish
    JournalBMJ Quality & Safety
    Early online date30 Oct 2012
    DOIs
    Publication statusPublished - 2012

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    Inpatients
    Scotland
    Patient Safety
    Workload
    Pharmacists
    Causality
    Documentation
    Accidents
    Communication
    Interviews
    Pharmaceutical Preparations

    Cite this

    Ross, Sarah ; Ryan, Cristín ; Duncan, Eilidh M. ; Francis, Jillian J. ; Johnston, Marie ; Ker, Jean S. ; Lee, Amanda Jane ; Macleod, Mary Joan ; Maxwell, Simon ; McKay, Gerard ; McLay, James ; Webb, David J. ; Bond, Christine. / Perceived causes of prescribing errors by junior doctors in hospital inpatients : a study from the PROTECT programme. In: BMJ Quality & Safety. 2012.
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    title = "Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme",
    abstract = "INTRODUCTION: Prescribing errors are a major cause of patient safety incidents. Understanding the underlying factors is essential in developing interventions to address this problem. This study aimed to investigate the perceived causes of prescribing errors among foundation (junior) doctors in Scotland. METHODS: In eight Scottish hospitals, data on prescribing errors were collected by ward pharmacists over a 14-month period. Foundation doctors responsible for making a prescribing error were interviewed about the perceived causes. Interview transcripts were analysed using content analysis and categorised into themes previously identified under Reason's Model of Accident Causation and Human Error. RESULTS: 40 prescribers were interviewed about 100 specific errors. Multiple perceived causes for all types of error were identified and were categorised into five categories of error-producing conditions, (environment, team, individual, task and patient factors). Work environment was identified as an important aspect by all doctors, especially workload and time pressures. Team factors included multiple individuals and teams involved with a patient, poor communication, poor medicines reconciliation and documentation and following incorrect instructions from other members of the team. A further team factor was the assumption that another member of the team would identify any errors made. The most frequently noted individual factors were lack of personal knowledge and experience. The main task factor identified was poor availability of drug information at admission and the most frequently stated patient factor was complexity. CONCLUSIONS: This study has emphasised the complex nature of prescribing errors, and the wide range of error-producing conditions within hospitals including the work environment, team, task, individual and patient. Further work is now needed to develop and assess interventions that address these possible causes in order to reduce prescribing error rates.",
    author = "Sarah Ross and Crist{\'i}n Ryan and Duncan, {Eilidh M.} and Francis, {Jillian J.} and Marie Johnston and Ker, {Jean S.} and Lee, {Amanda Jane} and Macleod, {Mary Joan} and Simon Maxwell and Gerard McKay and James McLay and Webb, {David J.} and Christine Bond",
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    Ross, S, Ryan, C, Duncan, EM, Francis, JJ, Johnston, M, Ker, JS, Lee, AJ, Macleod, MJ, Maxwell, S, McKay, G, McLay, J, Webb, DJ & Bond, C 2012, 'Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme', BMJ Quality & Safety. https://doi.org/10.1136/bmjqs-2012-001175

    Perceived causes of prescribing errors by junior doctors in hospital inpatients : a study from the PROTECT programme. / Ross, Sarah; Ryan, Cristín; Duncan, Eilidh M.; Francis, Jillian J.; Johnston, Marie; Ker, Jean S.; Lee, Amanda Jane; Macleod, Mary Joan; Maxwell, Simon; McKay, Gerard; McLay, James; Webb, David J.; Bond, Christine.

    In: BMJ Quality & Safety, 2012.

    Research output: Contribution to journalArticle

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    T1 - Perceived causes of prescribing errors by junior doctors in hospital inpatients

    T2 - a study from the PROTECT programme

    AU - Ross, Sarah

    AU - Ryan, Cristín

    AU - Duncan, Eilidh M.

    AU - Francis, Jillian J.

    AU - Johnston, Marie

    AU - Ker, Jean S.

    AU - Lee, Amanda Jane

    AU - Macleod, Mary Joan

    AU - Maxwell, Simon

    AU - McKay, Gerard

    AU - McLay, James

    AU - Webb, David J.

    AU - Bond, Christine

    PY - 2012

    Y1 - 2012

    N2 - INTRODUCTION: Prescribing errors are a major cause of patient safety incidents. Understanding the underlying factors is essential in developing interventions to address this problem. This study aimed to investigate the perceived causes of prescribing errors among foundation (junior) doctors in Scotland. METHODS: In eight Scottish hospitals, data on prescribing errors were collected by ward pharmacists over a 14-month period. Foundation doctors responsible for making a prescribing error were interviewed about the perceived causes. Interview transcripts were analysed using content analysis and categorised into themes previously identified under Reason's Model of Accident Causation and Human Error. RESULTS: 40 prescribers were interviewed about 100 specific errors. Multiple perceived causes for all types of error were identified and were categorised into five categories of error-producing conditions, (environment, team, individual, task and patient factors). Work environment was identified as an important aspect by all doctors, especially workload and time pressures. Team factors included multiple individuals and teams involved with a patient, poor communication, poor medicines reconciliation and documentation and following incorrect instructions from other members of the team. A further team factor was the assumption that another member of the team would identify any errors made. The most frequently noted individual factors were lack of personal knowledge and experience. The main task factor identified was poor availability of drug information at admission and the most frequently stated patient factor was complexity. CONCLUSIONS: This study has emphasised the complex nature of prescribing errors, and the wide range of error-producing conditions within hospitals including the work environment, team, task, individual and patient. Further work is now needed to develop and assess interventions that address these possible causes in order to reduce prescribing error rates.

    AB - INTRODUCTION: Prescribing errors are a major cause of patient safety incidents. Understanding the underlying factors is essential in developing interventions to address this problem. This study aimed to investigate the perceived causes of prescribing errors among foundation (junior) doctors in Scotland. METHODS: In eight Scottish hospitals, data on prescribing errors were collected by ward pharmacists over a 14-month period. Foundation doctors responsible for making a prescribing error were interviewed about the perceived causes. Interview transcripts were analysed using content analysis and categorised into themes previously identified under Reason's Model of Accident Causation and Human Error. RESULTS: 40 prescribers were interviewed about 100 specific errors. Multiple perceived causes for all types of error were identified and were categorised into five categories of error-producing conditions, (environment, team, individual, task and patient factors). Work environment was identified as an important aspect by all doctors, especially workload and time pressures. Team factors included multiple individuals and teams involved with a patient, poor communication, poor medicines reconciliation and documentation and following incorrect instructions from other members of the team. A further team factor was the assumption that another member of the team would identify any errors made. The most frequently noted individual factors were lack of personal knowledge and experience. The main task factor identified was poor availability of drug information at admission and the most frequently stated patient factor was complexity. CONCLUSIONS: This study has emphasised the complex nature of prescribing errors, and the wide range of error-producing conditions within hospitals including the work environment, team, task, individual and patient. Further work is now needed to develop and assess interventions that address these possible causes in order to reduce prescribing error rates.

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    M3 - Article

    JO - BMJ Quality & Safety

    JF - BMJ Quality & Safety

    SN - 2044-5415

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