How frequent are prescribing errors and near misses among traditional and non-traditional prescribers and how are they experienced?

摘要

BackgroundudNurses, midwives, health visitors, pharmacists, chiropodists and othersudhave all begun to assume the role of prescriber of medicines. However,udlittle work has been done comparing how effective these prescribers are inudrelation to the medical or traditional prescribers; and even less looking at theudoverall safety of prescribing in relation to errors and near misses. Thisudstudy examines the safety element to prescribing and encompasses trainingudto prescribe, prescribing in practice, support required, errors and nearudmisses and the experience of both traditional and non-traditionaludpractitioners.udMethodsudEmbedded single case study analysis was used which included threeudsubunits; analysis of one year of reported errors and near misses, semistructuredudinterviews with each group of prescribers and a review of archivaludrecords of prescribing. Prescriptions were analysed using a validated errorudtool and interviews were analysed using Colazzi's procedural steps (1978);udall data were then reviewed using the Brunswikian lens model (Scholz &udTietje 2002).udResultsudAll prescribers wanted better initial prescribing education and continualudupdates once qualified.udNon-traditional prescribers made fewer errors than traditional prescribers,udthough they do have a higher near miss rate than traditional prescribers.ud3 udPrescribers use a range of staff for support, though non-traditionaludprescribers are more likely to use their peer group.udTraditional prescribers have a more relaxed attitude to mistakes.udPrescribing staff do not trust the incident reporting system primarily sinceudthere is no useful feedback given which would improve prescribingudpractices.udConclusionsudThe trust needs to work with educational institutions to improve prescribingudtraining for all staff. They also need to ensure that there is some methodudavailable for all prescribers to be regularly updated or tested on their abilityudto prescribe.udErrors or near miss incidents involving prescribing must be shared with alludprescribers so that everyone can learn from them.udThis information is transferable to other, similar institutions.