Feedback on prescribing errors to junior doctors: exploring views, problems and preferred methods
- 541 Downloads
Background Prescribing errors are common in hospital inpatients. However, the literature suggests that doctors are often unaware of their errors as they are not always informed of them. It has been suggested that providing more feedback to prescribers may reduce subsequent error rates. Only few studies have investigated the views of prescribers towards receiving such feedback, or the views of hospital pharmacists as potential feedback providers. Objectives Our aim was to explore the views of junior doctors and hospital pharmacists regarding feedback on individual doctors’ prescribing errors. Objectives were to determine how feedback was currently provided and any associated problems, to explore views on other approaches to feedback, and to make recommendations for designing suitable feedback systems. Setting A large London NHS hospital trust. Methods To explore views on current and possible feedback mechanisms, self-administered questionnaires were given to all junior doctors and pharmacists, combining both 5-point Likert scale statements and open-ended questions. Main outcome measures Agreement scores for statements regarding perceived prescribing error rates, opinions on feedback, barriers to feedback, and preferences for future practice. Results Response rates were 49 % (37/75) for junior doctors and 57 % (57/100) for pharmacists. In general, doctors did not feel threatened by feedback on their prescribing errors. They felt that feedback currently provided was constructive but often irregular and insufficient. Most pharmacists provided feedback in various ways; however some did not or were inconsistent. They were willing to provide more feedback, but did not feel it was always effective or feasible due to barriers such as communication problems and time constraints. Both professional groups preferred individual feedback with additional regular generic feedback on common or serious errors. Conclusion Feedback on prescribing errors was valued and acceptable to both professional groups. From the results, several suggested methods of providing feedback on prescribing errors emerged. Addressing barriers such as the identification of individual prescribers would facilitate feedback in practice. Research investigating whether or not feedback reduces the subsequent error rate is now needed.
KeywordsFeedback Medication error Prescribing error United Kingdom
The Centre for Medication Safety and Service Quality, and the Centre for Infection Prevention and Management are affiliated with the Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust which is funded by the National Institute of Health Research.
Conflicts of interest
- 1.Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. London: General Medical Council; December 2009. Available at http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf Date last Accessed 26 Sept 2012.
- 13.The Health Foundation. Evidence: how safe are clinical systems? Primary research into the reliability of systems within seven NHS organisations. London, May 2011. Available at http://www.health.org.uk/public/cms/75/76/313/587/How%20safe%20are%20clinical%20systems%20full%20length%20publication.pdf?realName=OaJgi3.pdf Date last Accessed 26 Sept 2012.
- 14.Forsetlund L, Bjorndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009; 2: CD003030.Google Scholar
- 15.Farmer AP, Legare F, Turcot L, Grimshaw J, Harvey E, McGowan JL, et al. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008; 3: CD004398.Google Scholar
- 17.Department of Health Expert Group (Chaired by the Chief Medical Officer). An organisation with a memory. Report of an expert group on learning from adverse events in the NHS. London: The Stationery Office; 2000. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4065083 Date last Accessed 26 Sept 2012.
- 18.Caldwell G. Real time “check and correct” of drug charts on ward rounds—a process for improving doctors’ habits in inpatient prescribing. Pharm Manage. 2010;26(4):3–9.Google Scholar