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Publication of project reducing prescribing errors in junior doctors

Doctors were enrolled in a programme of written assessment in prescribing skills and individualised feedback. Audit showed significant error reduction.

The problem

The most common form of medication error has, for paediatric patients, been identified as physicians' prescribing error. It has been estimated that the incidence of paediatric dosing errors is about 500 000 per year in England. Strategies to reduce errors have included increased input from clinical pharmacists, system change implemented by critical incident analysis, recently computerised physician order entry (CPOE), and computer-aided prescribing.

Aims

(1) to reduce prescribing errors putting paediatric patients at risk of harm; (2) to reduce the risk associated with lack of necessary information for safe transcribing; (3) to reduce the risk associated with lack of acting on prescriptions with errors.

Making the case for change

Prescribing skills were assessed by asking paediatric trainee doctors to complete 5 tasks relating to prescribing as part of the induction programme, on commencement of their post at Luton and Dunstable Hospital NHS Foundation Trust, United Kingdom. The task comprised of transcribing a drug chart containing deliberate errors, two scenarios requiring prescription, and two tasks with instructions for prescription of intravenous drugs. Trainees were given one hour to complete the tasks and had a calculator and the British National Formulary for Children with information on all medication and doses including indications, contraindications, and allergy information available for reference. One pharmacist (B. Sun) and one paediatrician (M. Eisenhut) reviewed the outcome of the assessment with the 5- point questionnaire, and the pharmacist e-mailed assessed trainees with a detailed personalised feedback on correct and incorrect answers for each question individually.  Pharmacists audited the impact and compared to a baseline audit.

Your improvement

The training in prescribing is part of every junior doctor's induction now. Audit of impact of this intervention revealed a reduction of errors from 47 to 21, and patients affected from 19 to 11 per 100 (P = 0.001) emergency admissions compared to an audit before the intervention.

Learning and next steps

Electronic prescribing has been introduced since this project started. Errors associated with electronic prescribing are now being analysed and tailored training programmes are being designed. The secret of success was introducing into induction routine and pharmacist led training and monthly audit.

Quality assurance/MHRA Registration

External refereed publication