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Who makes prescribing decisions in hospital inpatients? An observational study
  1. Sarah Ross1,
  2. Laura Hamilton1,
  3. Cristin Ryan2,
  4. Christine Bond3
  1. 1Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK
  2. 2School of Pharmacy, Queen's University Belfast, UK
  3. 3Centre for Academic Primary Care, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Sarah Ross, Senior Clinical Teaching Fellow, Division of Medical and Dental Education, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK; s.ross{at}


Purpose of the study Errors involving drug prescriptions are a key target for patient safety initiatives. Recent studies have focused on error rates across different grades of doctors in order to target interventions. However, many prescriptions are not instigated by the doctor who writes them. It is important to clarify how often this occurs in order to interpret these studies and create interventions. This study aimed to provisionally quantify and describe prescriptions where the identity of the decision maker and prescription writer differed.

Design of the study Observational data was collected in six wards, 2 weeks per ward, at a single large UK teaching hospital over a 12-week period from January to April 2011.

Results In 112/183 (61%) cases where a new medicine was prescribed, the decision maker was not the prescription writer.

Conclusions Decision making and the writing of prescriptions are generally not undertaken by the same doctor. Moreover, communication about prescriptions is poor. Further research in a larger sample of hospitals is required to confirm generalisability of the results, and to inform educational interventions to reduce error rates.

  • Prescribing
  • junior doctors
  • decision making
  • medical education
  • clinical pharmacology
  • medical education training
  • internal medicine
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  • Funding This study was undertaken by LH as part of her intercalated BSc studies. There was no external funding.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by North of Scotland Research Ethics Service.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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