Junior doctors need training to reduce prescribing errors

A qualitative UK study in this week’s issue of THE LANCET suggests that prescribing errors in hospitals are a consequence of poor understanding of drug prescribing. Authors of the study conclude that junior doctors should be trained in the principles of drug dosing, and that medical staff should promote a working culture which recognises the importance of prescription writing.

Errors made during drug prescription are the most common type of avoidable medication error. The UK Department of Health is committed to reducing the number of serious errors involving prescribed drugs by 40% over the next three years; similar initiatives have been proposed in the USA. Theories of human error (used to understand the causes of mistakes made in high-risk industries) are being used in health care. Bryony Dean and colleagues from the School of Pharmacy, University of London, UK, used this approach to investigate the causes of prescribing errors within an in-patient hospital setting.

The investigators interviewed staff who made 44 potentially serious prescribing errors identified by hospital pharmacists, and analysed their findings with human-error theory. Half of the interviews were with senior house officers, and a third were with junior house officers. Other sources of prescribing errors included specialist registrars and a medical student.

Most mistakes were made because of slips in attention, or because prescribers did not apply relevant rules. Doctors identified many risk factors: work environment, workload, whether or not they were prescribing for their own patient, communication within their team, physical and mental well-being, and lack of knowledge. Organisational factors were also identified, and included inadequate training, low perceived importance of prescribing, a hierarchical medical team, and an absence of self-awareness of errors.

Bryony Dean comments: “To reduce prescribing errors, hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation. They should also create a culture in which prescription writing is seen as important, and formally review interventions made by pharmacists, locum arrangements, and the workload of junior doctors, and make doctors aware of situations in which they are likely to commit errors.”

Contact: Dr Bryony Dean, Centre for Practice and Policy, School of Pharmacy, University of London, London , UK; T)020 8383 4308 F)020 8383 1568 E) bdean@hhnt.org

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