Assessment of the knowledge and attitudes of intern doctors to medication prescribing errors in a Nigeria tertiary hospital

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Abstract

Context:

Junior doctors are reported to make most of the prescribing errors in the hospital setting.

Aims:

The aim of the following study is to determine the knowledge intern doctors have about prescribing errors and circumstances contributing to making them.

Settings and Design:

A structured questionnaire was distributed to intern doctors in National Hospital Abuja Nigeria.

Subjects and Methods:

Respondents gave information about their experience with prescribing medicines, the extent to which they agreed with the definition of a clinically meaningful prescribing error and events that constituted such. Their experience with prescribing certain categories of medicines was also sought.

Statistical Analysis Used:

Data was analyzed with Statistical Package for the Social Sciences (SPSS) software version 17 (SPSS Inc Chicago, Ill, USA). Chi-squared analysis contrasted differences in proportions; P < 0.05 was considered to be statistically significant.

Results:

The response rate was 90.9% and 27 (90%) had <1 year of prescribing experience. 17 (56.7%) respondents totally agreed with the definition of a clinically meaningful prescribing error. Most common reasons for prescribing mistakes were a failure to check prescriptions with a reference source (14, 25.5%) and failure to check for adverse drug interactions (14, 25.5%). Omitting some essential information such as duration of therapy (13, 20%), patient age (14, 21.5%) and dosage errors (14, 21.5%) were the most common types of prescribing errors made. Respondents considered workload (23, 76.7%), multitasking (19, 63.3%), rushing (18, 60.0%) and tiredness/stress (16, 53.3%) as important factors contributing to prescribing errors. Interns were least confident prescribing antibiotics (12, 25.5%), opioid analgesics (12, 25.5%) cytotoxics (10, 21.3%) and antipsychotics (9, 19.1%) unsupervised.

Conclusions:

Respondents seemed to have a low awareness of making prescribing errors. Principles of rational prescribing and events that constitute prescribing errors should be taught in the practice setting.

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Most cited references 28

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Causes of prescribing errors in hospital inpatients: a prospective study.

HOWARD M. SCHACHTER, Charles A Vincent, Nick Barber … (2002)

To prevent errors made during the prescription of drugs, we need to know why they arise. Theories of human error used to understand the causes of mistakes made in high-risk industries are being used in health-care. They have not, however, been applied to prescribing errors, which are a great cause of patient harm. Our aim was to use this approach to investigate the causes of such errors. Pharmacists at a UK teaching hospital prospectively identified 88 potentially serious prescribing errors. We interviewed the prescribers who made 44 of these, and analysed our findings with human error theory. Our results suggest that most mistakes were made because of slips in attention, or because prescribers did not apply relevant rules. Doctors identified many risk factors-work environment, workload, whether or not they were prescribing for their own patient, communication within their team, physical and mental well-being, and lack of knowledge. Organisational factors were also identified, and included inadequate training, low perceived importance of prescribing, a hierarchical medical team, and an absence of self-awareness of errors. To reduce prescribing errors, hospitals should train junior doctors in the principles of drug dosing before they start prescribing, and enforce good practice in documentation. They should also create a culture in which prescription writing is seen as important, and formally review interventions made by pharmacists, locum arrangements, and the workload of junior doctors, and make doctors aware of situations in which they are likely to commit errors.

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Medication errors: definitions and classification.

Jeffrey Aronson (2009)

1. To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them. 2. The four main approaches to defining technical terms consider etymology, usage, previous definitions, and the Ramsey-Lewis method (based on an understanding of theory and practice). 3. A medication error is 'a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient'. 4. Prescribing faults, a subset of medication errors, should be distinguished from prescription errors. A prescribing fault is 'a failure in the prescribing [decision-making] process that leads to, or has the potential to lead to, harm to the patient'. The converse of this, 'balanced prescribing' is 'the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm'. This excludes all forms of prescribing faults, such as irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing. 5. A prescription error is 'a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription'. The 'normal features' include the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. 6. Medication errors can be classified, invoking psychological theory, as knowledge-based mistakes, rule-based mistakes, action-based slips, and memory-based lapses. This classification informs preventive strategies.

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What is a prescribing error?

HOWARD M. SCHACHTER, Glen N. Barber, Jay B. Dean (2000)

To develop a practitioner led definition of a prescribing error for use in quantitative studies of their incidence. Two stage Delphi technique. A panel of 34 UK judges, which included physicians, surgeons, pharmacists, nurses and risk managers. The extent to which judges agreed with a general definition of a prescribing error, and the extent to which they agreed that each of 42 scenarios represented a prescribing error. Responses were obtained from 30 (88%) of 34 judges in the first Delphi round, and from 26 (87%) of 30 in the second round. The general definition of a prescribing error was accepted. The panel reached consensus that 24 of the 42 scenarios should be included as prescribing errors and that five should be excluded. In general, transcription errors, failure to communicate essential information, and the use of drugs or doses inappropriate for the individual patient were considered prescribing errors; deviations from policies or guidelines were not. Health care professionals are in broad agreement about the types of events that should be included and excluded as prescribing errors. A general definition of a prescribing error has been developed, together with more detailed guidance regarding the types of events that should be included. This definition allows the comparison of prescribing error rates among different prescribing systems and different hospitals, and is suitable for use in both research and clinical governance initiatives.

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Author and article information

Journal

Journal ID (nlm-ta): J Basic Clin Pharm

Journal ID (iso-abbrev): J Basic Clin Pharm

Journal ID (publisher-id): JBCP

Title: Journal of Basic and Clinical Pharmacy

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0976-0105

ISSN (Electronic): 0976-0113

Publication date (Print): December 2013-February 2014

Volume: 5

Issue: 1

Pages: 7-14

Affiliations

[1] Department of Pharmacy, National Hospital Abuja, Abuja, Nigeria

[1 ] Department of Clinical Pharmacy and Pharmacy Administration, University of Ibadan, Ibadan, Oyo State, Nigeria

[2 ] Department of Statistics, University of Abuja, Vatican Street, Saburi District, Abuja, Nigeria

[3 ] Department of Clinical Pharmacy and Pharmacy Administration, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

Author notes

Address for correspondence: Mrs. Adetutu A. Ajemigbitse, Department of Pharmacy, National Hospital Abuja, Nigeria. E-mail: tutsade2002@ 123456yahoo.com

Article

Publisher ID: JBCP-5-7

DOI: 10.4103/0976-0105.128244

PMC ID: 4012704

PubMed ID: 24808682

SO-VID: 80639074-c5e6-4b04-8d82-061b6f28bcdd

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Assessment of the knowledge and attitudes of intern doctors to medication prescribing errors in a Nigeria tertiary hospital

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Abstract

Context:

Aims:

Settings and Design:

Subjects and Methods:

Statistical Analysis Used:

Results:

Conclusions:

Related collections

Indigenous Knowledge

Most cited references 28

Causes of prescribing errors in hospital inpatients: a prospective study.

Medication errors: definitions and classification.

What is a prescribing error?

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