Prescribing errors
Overview
Accurate and error-free prescribing is fundamental to ensuring patients benefit from their medicines and do not suffer harm. In this section, the prevalence and nature of prescribing errors will be explored along with the causes of prescribing errors. Solutions to minimising the risk of erroneous prescribing will be discussed.
What are prescribing errors and how often do they occur?
Medication errors have been defined as a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient (Ferner and Aronson, 2006) and can occur in the prescribing, dispensing, administration or monitoring of medicines (Alldred et al, 2008). In this section, we will focus on your role as a prescriber and therefore, only prescribing errors will be considered. Dean et al (2000) defined ‘clinically meaningful’ prescribing errors as occurring when:
'as a result of a prescribing decision or prescription writing process, there is an unintentional significant (i) reduction in the probability of treatment being timely and effective; or (ii) increase in the risk of harm when compared with generally accepted practice.'
It is difficult to compare studies of prescribing error prevalence due to different definitions and methods of data collection (Franklin et al, 2005), however, what is clear is that prescribing errors are common in all settings. A systematic review of the prevalence of prescribing errors in hospitals found a median error rate of 7% (interquartile range 2-14%) of all medication orders (Lewis et al, 2009). A recent study of prescribing errors made by first-year foundation trainee doctors in UK hospitals found a mean error rate of 8.4% (Dornan et al, 2009). In UK general practice, Shah et al (2001) found an error rate of 7.5% and a study in care homes for older people found an error rate of 8.3% (Barber et al, 2009).
How many reports do you think are received by NHS Improvement regarding medication errors in a year?
If you are working in a group, see what the others think. Remember this is reports processed so the actual number may be significantly higher.
Activity
In 2017/18 NHS Improvement received reports of over 14000 medication incidents in the acute and community setting. The actual incidence is likely to be much higher. Think about the type of errors that may be included here. There are many ways to commit a prescribing error, with dosage errors being the most common (Lewis et al, 2009). Other types of error include: incomplete prescriptions, omission of medicines, illegible prescriptions, dose frequency errors, incorrect formulation, drug-disease interactions, drug-drug interactions, prescribing unnecessary medicines and errors in transcription (Alldred et al, 2008; Lewis et al, 2009). Not all of these are the responsibility of the prescriber – but many are.
Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.