Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes
- 1Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust and The School of Pharmacy, University of London, London, UK
- 2Pharmacy Department, Charing Cross Hospital, London, UK
- 3Department of Practice and Policy, The School of Pharmacy, University of London, London, UK
- 4Centre for Patient Safety and Service Quality, Imperial College London, London, UK
- 5Division of Surgery and Cancer, Department of Surgery, St Mary's Campus, Norfolk Place, London, UK
- Correspondence to Bryony Dean Franklin, Pharmacy Department, Ground Floor, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK;
- Received 19 January 2011
- Accepted 10 June 2011
- Published Online First 14 July 2011
Aim To compare the prevalence and causes of prescribing errors in newly written medication orders and how quickly they were rectified, in three NHS organisations.
Methods Errors in newly written inpatient and discharge medication orders were recorded in Spring/Summer 2009 by ward pharmacists on medical admissions and surgical wards, as well as the number of erroneous doses administered (or omitted) before errors were corrected. Logistic regression analysis was used to explore the effects of ward (nested within organisation) and clinical specialty, and whether the pharmacist had checked the patient's medication history during data collection. Causes were explored using semistructured interviews with key informants.
Results Overall, 1025 prescribing errors were identified in 974 of 6605 medication orders (14.7%, 95% confidence interval (CI) 13.8% to 15.6%). A mean of 0.9 doses were administered (or omitted) before each error was corrected (range 0–11), with differences between specialties and organisations. The error rate on medical admissions wards (16.3%) was significantly higher than that on surgical wards (12.2%), but this was accounted for by the higher proportion of prescribing being on admission, where omission of patients' usual medication was often identified. There were significant differences among wards (and organisations). Contributing factors included lack of feedback on errors, poor documentation and communication of prescribing decisions, and lack of information about patients' medication histories from primary care.
Conclusions There were variations among wards, organisations and specialties in error rates and how quickly they were rectified. Exploring reasons for differences between organisations may be useful in identifying best practice and potential solutions.
Some preliminary results of this work were presented as two conference abstracts: Franklin BD. A multi-centre study of prescribing errors in hospital inpatients. Abstract Presented at the Patient Safety Congress. Birmingham. 25–26 May 2010. Franklin BD, Reynolds M. A comparative study of prescribing errors in three NHS organisations. Abstract Presented at Royal Pharmaceutical Society Conference. London. 5–6 September 2010.
Funding Material used in this paper is based on a Research Report commissioned in 2009 by the Health Foundation (registered charity number 286987). Available at http://www.health.org.uk/publications/evidence-in-brief-how-safe-are-clinical-systems (accessed 31 Mar 2011). Other funders: Health Foundation, NIHR.
Competing interests None.
Ethics approval This study was conducted with the approval of the Hammersmith and Queen Charlotte's & Chelsea Research Ethics Committee, reference number 09/H0707/27.
Provenance and peer review Not commissioned; externally peer reviewed.