title: Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study.
abstract: OBJECTIVE
  Study objectives were to investigate the prevalence and causes of prescribing errors amongst foundation doctors (i.e. junior doctors in their first (F1) or second (F2) year of post-graduate training), describe their knowledge and experience of prescribing errors, and explore their self-efficacy (i.e. confidence) in prescribing.
  
  
  METHODS
  A three-part mixed-methods design was used, comprising: prospective observational study; semi-structured interviews and cross-sectional survey. All doctors prescribing in eight purposively selected hospitals in Scotland participated. All foundation doctors throughout Scotland participated in the survey. The number of prescribing errors per patient, doctor, ward and hospital, perceived causes of errors and a measure of doctors' self-efficacy were established.
  
  
  RESULTS
  4710 patient charts and 44,726 prescribed medicines were reviewed. There were 3364 errors, affecting 1700 (36.1%) charts (overall error rate: 7.5%; F1:7.4%; F2:8.6%; consultants:6.3%). Higher error rates were associated with : teaching hospitals (p<0.001), surgical (p = <0.001) or mixed wards (0.008) rather thanmedical ward, higher patient turnover wards (p<0.001), a greater number of prescribed medicines (p<0.001) and the months December and June (p<0.001). One hundred errors were discussed in 40 interviews. Error causation was multi-factorial; work environment and team factors were particularly noted. Of 548 completed questionnaires (national response rate of 35.4%), 508 (92.7% of respondents) reported errors, most of which (328 (64.6%) did not reach the patient. Pressure from other staff, workload and interruptions were cited as the main causes of errors. Foundation year 2 doctors reported greater confidence than year 1 doctors in deciding the most appropriate medication regimen.
  
  
  CONCLUSIONS
  Prescribing errors are frequent and of complex causation. Foundation doctors made more errors than other doctors, but undertook the majority of prescribing, making them a key target for intervention. Contributing causes included work environment, team, task, individual and patient factors. Further work is needed to develop and assess interventions that address these.
authors.affiliation: School of Pharmacy, Queen's University Belfast, Belfast, United Kindgom.
authors.forename: Cristín
authors.initials: C
authors.lastname: Ryan
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ross
authors.affiliation: School of Medicine, University of Dundee, Dundee, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Davey
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Eilidh M
authors.initials: EM
authors.lastname: Duncan
authors.affiliation: Health Services Research and Management Division, City University London, London, United Kingdom.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.affiliation: Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Shona
authors.initials: S
authors.lastname: Fielding
authors.affiliation: Health Psychology, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.affiliation: School of Medicine, University of Dundee, Dundee, United Kingdom.
authors.forename: Jean
authors.initials: J
authors.lastname: Ker
authors.affiliation: Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Amanda Jane
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Mary Joan
authors.initials: MJ
authors.lastname: MacLeod
authors.affiliation: Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, United Kindgom.
authors.forename: Simon
authors.initials: S
authors.lastname: Maxwell
authors.affiliation: Department of Clinical Pharmacology, Glasgow Royal Infirmary, Glasgow, United Kindgom.
authors.forename: Gerard A
authors.initials: GA
authors.lastname: McKay
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: James S
authors.initials: JS
authors.lastname: McLay
authors.affiliation: Clinical Pharmacology Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kindgom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Webb
authors.affiliation: Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Christine
authors.initials: C
authors.lastname: Bond
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D010820:Physicians / Q000592:standards*; D015995:Prevalence; D011446:Prospective Studies; D020377:Self Efficacy; D011795:Surveys and Questionnaires