Monday, April 19, 2010

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Newly qualified doctors are twice as likely to make a mistake in prescribing than a consultant, but second-year doctors made the most errors, according to a study commissioned by the General Medical Council, the UK newspaper The Telegraph reported Dec. 3.

The mistakes included omitting drugs, wrong doses, not taking account of a patient's allergies, illegible handwriting or ambiguous orders.

In the study 124,260 prescriptions were checked by pharmacists in 19 hospitals in England and 11,077 errors were detected.

It is no t known how many errors were not picked up by the pharmacist and so the figures are a 'minimum, the researchers admitted.

When doctors were interviewed about their mistakes some admitted that they relied on the pharmacist to correct them. The report said: "The pharmacist safety net was used by some as part of their prescribing process; when they were uncertain about their prescribing they relied on pharmacists to pick up their errors or fill in the gaps in their prescribing."

No patients in the study, conducted by a team at Manchester University, were harmed as a result, probably because pharmacists were checking the prescriptions before the drugs were issued, they said.

The study found potentially fatal errors were found in fewer than 2% of the prescriptions that had mistakes in them.

One in 20 of the errors were potentially serious in that they may have included a dose that was too low or toxically high, and more than half were classed as 'potentially significant', including sending patients home without relevant medication.

Many of the errors were associated with drug charts which doctors were unfamiliar with as each NHS hospital may use a different version. The General Medical Council has called for a single drug chart to be used as standard across the NHS. A standard chart was introduced in Wales in 2004 but it is not known if this has resulted in a drop in prescribing errors.

Peter Rubin, chairman of the General Medical Council and Professor of Therapeutics at Nottingham University, said newly qualified doctors made mistakes in 8.4% of their prescriptions but also wrote the most prescriptions. Doctors in their second year since qualifying made errors in more than one in ten, while registrars made mistakes in 8.3% of their drug orders.

Consultants made the fewest mistakes, in 5.9% of their drug orders, he said.

Rubin said: "Prescribing decisions in a hospital setting often have to be made quickly, so it is important that a procedure is as simple as possible to minimize the chance of an error being made.

"However, all doctors have to remain vigilant to the simple mistakes that can happen as a result of poor communication and busy and stressful working environments."

Rubin said the research answered allegations that newly qualified doctors were harming patients through a lack of education about prescribing, because doctors of all grades made a similar number of prescribing errors.

Exams on prescribing will now be introduced for all medical students in their final year before graduation. Rubin said the exam will 'underline' the fact that writing a prescription is a very important event as it can sometimes be seen as 'pedestrian.'

The research team now wants to carry out more research into why the second-year doctors have the highest prescribing errors and also to investigate prescribing among GPs.

The National Patient Safety Agency (NPSA) and the National Institute for Health and Clinical Excellence issued guidance two years ago on how to reduce prescribing errors when patients are admitted to a hospital and discharged home.

Earlier this year the NPSA reported that almost one million NHS patients a year were being given the wrong medication, the incorrect dose of the correct medicine, being given drugs late or in the wrong way.

Source Citation
"UK study finds docs erred on 'one in 10 hospital prescriptions'." Adverse Event Reporting News 6.23 (2009): 1+. Academic OneFile. Web. 19 Apr. 2010.
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