Exploring the causes of junior doctors' prescribing mistakes: a qualitative study

Penny J. Lewis*, Darren M. Ashcroft, Tim Dornan, David Taylor, Val Wass, Mary P. Tully

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

48 Citations (Web of Science)

Abstract

AIMS Prescribing errors are common and can be detrimental to patient care and costly. Junior doctors are more likely than consultants to make a prescribing error, yet there is only limited research into the causes of errors. The aim of this study was to explore the causes of prescribing mistakes made by doctors in their first year post graduation. METHODS As part of the EQUIP study, interviews using the critical incident technique were carried out with 30 newly qualified doctors. Participants were asked to discuss in detail any prescribing errors they had made. Participants were purposely sampled across a range of medical schools (18) and hospitals (15). A constant comparison approach was taken to analysis and Reason's model of accident causation was used to present the data. RESULTS More than half the errors discussed were prescribing mistakes (errors due to the correct execution of an incorrect plan). Knowledge-based mistakes (KBMs) appeared to arise from poor knowledge of practical aspects of prescribing such as dosing, whereas rule-based mistakes (RBMs) resulted from inappropriate application of knowledge. Multiple error-producing and latent conditions were described by participants for RBMs and KBMs. Poor/absent senior support and a fear of appearing incompetent occurred with KBMs. Following erroneous routines or seniors' orders were major contributory factors in RBMs. CONCLUSIONS Although individual factors such as knowledge and expertise played a role in prescribing mistakes, there were many perceived interrelated factors contributing to error. We conclude that multiple interventions are necessary to address these and further research is essential.
Original languageEnglish
Pages (from-to)310-319
JournalBritish Journal of Clinical Pharmacology
Volume78
Issue number2
DOIs
Publication statusPublished - Aug 2014

Keywords

  • critical incident technique
  • hospitalists
  • internship
  • medication errors
  • qualitative research

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