Prevalence and Causes of Prescribing Errors: The PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study

被引:128
|
作者
Ryan, Cristin [1 ]
Ross, Sarah [2 ]
Davey, Peter [3 ]
Duncan, Eilidh M. [4 ]
Francis, Jill J. [5 ]
Fielding, Shona [6 ]
Johnston, Marie [7 ]
Ker, Jean [3 ]
Lee, Amanda Jane [6 ]
MacLeod, Mary Joan [2 ]
Maxwell, Simon [8 ]
McKay, Gerard A. [9 ]
McLay, James S. [2 ]
Webb, David J. [10 ]
Bond, Christine [11 ]
机构
[1] Queens Univ Belfast, Sch Pharm, Belfast, Antrim, North Ireland
[2] Univ Aberdeen, Sch Med & Dent, Aberdeen, Scotland
[3] Univ Dundee, Sch Med, Dundee, Scotland
[4] Univ Aberdeen, Hlth Serv Res Unit, Aberdeen, Scotland
[5] City Univ London, Hlth Serv Res & Management Div, London EC1V 0HB, England
[6] Univ Aberdeen, Med Stat Team, Aberdeen, Scotland
[7] Univ Aberdeen, Aberdeen, Scotland
[8] Univ Edinburgh, Clin Pharmacol Unit, Edinburgh, Midlothian, Scotland
[9] Glasgow Royal Infirm, Dept Clin Pharmacol, Glasgow G4 0SF, Lanark, Scotland
[10] Univ Edinburgh, Royal Infirm Edinburgh, Clin Pharmacol Unit, Edinburgh, Midlothian, Scotland
[11] Univ Aberdeen, Ctr Acad Primary Care, Aberdeen, Scotland
来源
PLOS ONE | 2014年 / 9卷 / 01期
关键词
IN-HOSPITAL INPATIENTS; MEDICAL-STUDENTS; JUNIOR DOCTORS; INTERVENTIONS;
D O I
10.1371/journal.pone.0079802
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
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 than medical 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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页数:9
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