Perceptions of prescribing violations by doctors: A qualitative study using semi-structured interviews

Prescribing violations-deliberate deviations from prescribing rules or guidelines-are a recognized subtype of error but have received limited attention in clinical practice research. Although prescribing errors are common, violations are often under-reported and may be normalized in busy hospital environments.

To explore how Foundation Year 2 (FY2) doctors perceive prescribing violations in everyday clinical practice.

Twelve FY2 doctors from multiple UK hospitals participated in semi-structured interviews. Two real prescribing-violation scenarios, presented on example drug charts, were used to prompt discussion. Interviews were audio-recorded, transcribed verbatim and analysed thematically using a deductive framework based on Reason's taxonomy (routine, situational, optimizing violations) alongside inductive constant comparison to identify additional themes.

Participants described routine and situational violations as common, normalized and often necessary responses to workload, time pressure and organizational constraints. Optimizing violations were not identified. Key influences included diffusion of responsibility (reliance on pharmacists and nurses to detect errors), hierarchical pressures, informal categorization of drugs as 'safe' or 'dangerous' and limited feedback about prescribing errors. Participants perceived many violations as low-risk and viewed safety nets as compensating for shortcuts.

FY2 doctors in this study perceived prescribing violations as an embedded and often unavoidable part of practice. These perceptions highlight the need for organizations to design workable prescribing systems, clarify responsibility for prescription accuracy, improve feedback mechanisms and support junior clinicians in challenging unsafe norms.