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Improving feedback on junior doctors' prescribing errors: mixed-methods evaluation of a quality improvement project
Matthew Reynolds1, Seetal Jheeta1, Jonathan Benn2
1Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
Background:
Prescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation.
Aim:
To reduce prescribing errors in a UK hospital by improving feedback on prescribing errors.
Interventions:
We developed three linked interventions using plan-do-study-act cycles: (1) name stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to provide feedback to doctors on individual prescribing errors and (3) fortnightly prescribing advice emails that addressed a common and/or serious error.
Implementation And Evaluation:
Interventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctors stated their name. Outcome measures were junior doctors' and pharmacists' perceptions of current feedback provision (evaluated using quantitative pre-questionnaires and post-questionnaires and qualitative focus groups) and the prevalence of erroneous medication orders written by junior doctors between August and December 2013.
Results:
The percentage of medication orders for which junior doctors stated their name increased from about 10% to 50%. Questionnaire responses revealed a significant improvement in pharmacists' perceptions but no significant change for doctors. Focus group findings suggested increased doctor engagement with safe prescribing. Interrupted time series analysis showed no difference in weekly prescribing error rates between baseline and intervention periods, compared with the control site.
Conclusion:
Findings suggest improved experiences around feedback. However, attempts to produce a measurable reduction in prescribing errors are likely to need a multifaceted approach of which feedback should form part.
Insights
Junior doctors improved name clarity on prescriptions, enhancing pharmacist feedback. However, this intervention alone did not significantly reduce medication prescribing errors in the UK hospital setting.
Area of Science:
- Medical Safety
- Healthcare Quality Improvement
- Clinical Pharmacy
Background:
- Prescribing errors affect up to 15% of UK inpatient medication orders.
- Junior doctors report insufficient feedback on prescribing errors.
- Lack of prescriber identification on documentation hinders feedback.
Purpose of the Study:
- To reduce prescribing errors in a UK hospital.
- To improve feedback mechanisms for junior doctors regarding prescribing errors.
Main Methods:
- Implemented three interventions: name stamps for doctors, feedback training for pharmacists, and prescribing advice emails.
- Utilized plan-do-study-act cycles for intervention development.
- Compared an intervention site with a control site using process and outcome measures.
Main Results:
- The percentage of medication orders with junior doctors' names increased from 10% to 50%.
- Pharmacists' perceptions of feedback significantly improved, but doctors' perceptions did not change.
- No significant difference in weekly prescribing error rates was observed between the intervention and control sites.
Conclusions:
- The interventions improved feedback experiences for pharmacists and potentially increased doctor engagement.
- A multifaceted approach is likely necessary to achieve measurable reductions in prescribing errors.
- Feedback should be a component of broader strategies for improving medication safety.
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