Preventing prescribing errors
What’s the Evidence? Prescribing errors
A systematic review of the causes of prescribing errors in secondary care found that knowledge-based mistakes (lack of knowledge about the patient or the drug) were deemed to be the most frequent active failures (Tully et al, 2009). Slips and lapses were also found to be common. Error producing conditions included a lack of doctor training or experience, tiredness, stress, high workload and poor communication between health care professionals. A reluctance to question senior doctors and inadequate training were considered to be latent conditions. The causes of errors were multifactorial, often with multiple error producing conditions and active errors combining to lead to error.
What can be done to reduce errors?
As discussed above, the causes of prescribing errors are often complex and multifactorial; consequently, multi-faceted solutions are required to reduce errors. Clinical governance teams are responsible for designing and implementing safer systems in the NHS, however, in this section we will focus on what you, the individual doctor, can do to reduce the risk of error. Do you know who manages clinical governance in your organisation? Now is a good time to find out and identify their role. This will of course vary from organisation to organisation so there is no specific answer.
Reducing knowledge-based mistakes
As the prescriber, how would you attempt to reduce knowledge based mistakes based on what you have just read? Discuss this with colleagues to see how they approach the potential problem. Do you agree or are you each bringing different ideas which can supplement each other?
Activity
Some of your responses should have included the following:
Knowing your patient
Having comprehensive, accurate and up-to-date information about the patient is fundamental to safe prescribing. This includes knowing the patient’s conditions, drug sensitivities (allergies and previous adverse drug reactions), medication history and renal and hepatic function. Having this knowledge means that you can avoid prescribing contraindicated medicines, or you can tailor your prescribing to the individual for example, reducing doses in renal impairment. Obtaining an accurate medication history and ensuring patients are prescribed the correct medicines is particularly important when patients are transferred to and from different settings. This process is called medicines reconciliation and the National Institute for Health and Care Excellence (NICE) has produced guidelines on how and when medicines reconciliation should be carried out (NICE, 2007).
Knowing your drugs
Clearly, to be able to safely prescribe you need a good working knowledge of drugs including their indications, dosage, contraindications, cautions, drug-drug interactions and side-effects. Given that there are thousands of medicines available to the prescriber this is not an easy task. It is essential that you have access to high-quality information on medicines and if in doubt that you can quickly obtain the information you need. As well as textbooks and online materials, colleagues such as senior doctors, nurses and pharmacists will also be able to give guidance.
Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.