INTRODUCTION: It has been suggested that doctors in their first year of post-graduate training make a disproportionate number of prescribing errors.
OBJECTIVE: This study aimed to compare the prevalence of prescribing errors made by first-year post-graduate doctors with that of errors by senior doctors and non-medical prescribers and to investigate the predictors of potentially serious prescribing errors.
METHODS: Pharmacists in 20 hospitals over 7 prospectively selected days collected data on the number of medication orders checked, the grade of prescriber and details of any prescribing errors. Logistic regression models (adjusted for clustering by hospital) identified factors predicting the likelihood of prescribing erroneously and the severity of prescribing errors.
RESULTS: Pharmacists reviewed 26,019 patients and 124,260 medication orders; 11,235 prescribing errors were detected in 10,986 orders. The mean error rate was 8.8 % (95 % confidence interval [CI] 8.6-9.1) errors per 100 medication orders. Rates of errors for all doctors in training were significantly higher than rates for medical consultants. Doctors who were 1 year (odds ratio [OR] 2.13; 95 % CI 1.80-2.52) or 2 years in training (OR 2.23; 95 % CI 1.89-2.65) were more than twice as likely to prescribe erroneously. Prescribing errors were 70 % (OR 1.70; 95 % CI 1.61-1.80) more likely to occur at the time of hospital admission than when medication orders were issued during the hospital stay. No significant differences in severity of error were observed between grades of prescriber. Potentially serious errors were more likely to be associated with prescriptions for parenteral administration, especially for cardiovascular or endocrine disorders.
CONCLUSION: The problem of prescribing errors in hospitals is substantial and not solely a problem of the most junior medical prescribers, particularly for those errors most likely to cause significant patient harm. Interventions are needed to target these high-risk errors by all grades of staff and hence improve patient safety.
This study was funded by the General Medical Council (GMC). The study funders had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of this manuscript or in the decision to submit the article for publication.
The EQUIP team would like to thank the following people: Members of the Expert Reference Group (Graham Buckley, Gary Cook, Dianne Parker, Lesley Pugsley and Mike Scott); Members of the Error Validation Group (Lindsay Harper, Katy Mellor, Steven Williams, Keith Harkins, Steve McGlynn, Ray George, Tim Dornan, Penny Lewis); Tribal Consulting Ltd. (Heather Heathfield, Emma Carter) for database design; Study co-ordinators at hospitals (Linda Aldred, Deborah Armstrong, Isam Badhawi, Kathryn Ball, Neil Caldwell, Vanya Fidling, Nicholas Fong, Heather Ford, Andrea Gill, Lindsay Harper, Jean Holmes, Sally James, Christopher Poole, Sally Shaw, Heather Smith, Julie Street, Atia Rifat, David Thornton, Tracey Thornton, Jane Warren, Steven Williams), and all pharmacists at the study sites who collected data for this study.
- National Health Service
- Junior Doctor
- Improve Patient Safety
- Medication Order
- Senior Doctor