title: Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme.
abstract: BACKGROUND
  Prescribing errors are a major cause of patient safety incidents. Understanding the underlying factors is essential in developing interventions to address this problem. This study aimed to investigate the perceived causes of prescribing errors among foundation (junior) doctors in Scotland.
  
  
  METHODS
  In eight Scottish hospitals, data on prescribing errors were collected by ward pharmacists over a 14-month period. Foundation doctors responsible for making a prescribing error were interviewed about the perceived causes. Interview transcripts were analysed using content analysis and categorised into themes previously identified under Reason's Model of Accident Causation and Human Error.
  
  
  RESULTS
  40 prescribers were interviewed about 100 specific errors. Multiple perceived causes for all types of error were identified and were categorised into five categories of error-producing conditions, (environment, team, individual, task and patient factors). Work environment was identified as an important aspect by all doctors, especially workload and time pressures. Team factors included multiple individuals and teams involved with a patient, poor communication, poor medicines reconciliation and documentation and following incorrect instructions from other members of the team. A further team factor was the assumption that another member of the team would identify any errors made. The most frequently noted individual factors were lack of personal knowledge and experience. The main task factor identified was poor availability of drug information at admission and the most frequently stated patient factor was complexity.
  
  
  CONCLUSIONS
  This study has emphasised the complex nature of prescribing errors, and the wide range of error-producing conditions within hospitals including the work environment, team, task, individual and patient. Further work is now needed to develop and assess interventions that address these possible causes in order to reduce prescribing error rates.
authors.affiliation: Division of Medical and Dental Education, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen, UK. s.ross@abdn.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Ross
authors.forename: Cristín
authors.initials: C
authors.lastname: Ryan
authors.forename: Eilidh M
authors.initials: EM
authors.lastname: Duncan
authors.forename: Jillian J
authors.initials: JJ
authors.lastname: Francis
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: Jean S
authors.initials: JS
authors.lastname: Ker
authors.forename: Amanda Jane
authors.initials: AJ
authors.lastname: Lee
authors.forename: Mary Joan
authors.initials: MJ
authors.lastname: MacLeod
authors.forename: Simon
authors.initials: S
authors.lastname: Maxwell
authors.forename: Gerard
authors.initials: G
authors.lastname: McKay
authors.forename: James
authors.initials: J
authors.lastname: McLay
authors.forename: David J
authors.initials: DJ
authors.lastname: Webb
authors.forename: Christine
authors.initials: C
authors.lastname: Bond
mesh_terms: D015984:Causality; D002983:Clinical Competence / Q000592:standards*; D003144:Communication Barriers; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007297:Inpatients; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D008508:Medication Errors / Q000145:classification / Q000517:prevention & control / Q000523:psychology*; D010348:Patient Care Team; D061214:Patient Safety; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D036301:Qualitative Research; D012606:Scotland / Q000453:epidemiology; D016526:Workload