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. 2014 Jan 3;9(1):e79802.
doi: 10.1371/journal.pone.0079802. eCollection 2014.

Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study

Cristín Ryan  1 , Sarah Ross  2 , Peter Davey  3 , Eilidh M Duncan  4 , Jill J Francis  5 , Shona Fielding  6 , Marie Johnston  7 , Jean Ker  3 , Amanda Jane Lee  6 , Mary Joan MacLeod  2 , Simon Maxwell  8 , Gerard A McKay  9 , James S McLay  2 , David J Webb  10 , Christine Bond  11
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Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study

Cristín Ryan et al. PLoS One. .

Abstract

Objectives: Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.

Method: A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established.

Results: 4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p<0.001), surgical (p = <0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p<0.001), a greater number of prescribed medicines (p<0.001) and the months December and June (p<0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.

Conclusions: Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Frequency of reporting of suggested causes of prescribing error as per specified list (N = 504 errors).
(Note more than option could be selected).
Figure 2
Figure 2. Median responses of questionnaire F1 (n = 353) and F2 (n = 323) respondents to series of statements on consequences of prescribing (note vertical lines represent the IQR.
** denotes statistical difference between F1 and F2 responders <0.05.
Figure 3
Figure 3. Median responses of questionnaire F1 (n = 353) and F2 (n = 323) respondents to series of statements on self-efficacy (confidence) in prescribing (note vertical lines represent the IQR.
* denotes statistical difference between F1 and F2 responders <0.001.
See this image and copyright information in PMC

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