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

Area of Science:

• Medical Education
• Patient Safety
• Clinical Practice

Background:

• Prescribing errors pose significant risks to patient care and healthcare costs.
• Junior doctors are identified as a demographic with a higher propensity for prescribing errors.
• Limited research exists on the specific causes of prescribing errors among early-career physicians.

Purpose of the Study:

• To investigate the root causes of prescribing mistakes made by doctors in their first year after graduation.
• To identify factors contributing to prescribing errors in newly qualified physicians.
• To inform interventions aimed at reducing prescribing errors.

Main Methods:

• Utilized the critical incident technique through in-depth interviews with 30 newly qualified doctors.
• Employed purposive sampling across 18 medical schools and 15 hospitals.
• Applied constant comparison analysis and Reason's model of accident causation for data presentation.

Main Results:

• Over half of discussed errors were prescribing mistakes (execution of incorrect plans).
• Knowledge-based mistakes (KBMs) stemmed from inadequate practical prescribing knowledge (e.g., dosing).
• Rule-based mistakes (RBMs) resulted from incorrect application of knowledge, often influenced by poor senior support, fear of incompetence, erroneous routines, or senior directives.

Conclusions:

• Individual factors like knowledge gaps contribute to prescribing errors.
• Interrelated systemic factors significantly influence prescribing mistakes.
• Multiple, targeted interventions and further research are essential to mitigate these errors.