title: Exploring the causes of junior doctors' prescribing mistakes: a qualitative study.
abstract: OBJECTIVE
  Prescribing errors are common and can be detrimental to patient care and costly. Junior doctors are more likely than consultants to make a prescribing error, yet there is only limited research into the causes of errors. The aim of this study was to explore the causes of prescribing mistakes made by doctors in their first year post graduation.
  
  
  METHODS
  As part of the EQUIP study, interviews using the critical incident technique were carried out with 30 newly qualified doctors. Participants were asked to discuss in detail any prescribing errors they had made. Participants were purposely sampled across a range of medical schools (18) and hospitals (15). A constant comparison approach was taken to analysis and Reason's model of accident causation was used to present the data.
  
  
  RESULTS
  More than half the errors discussed were prescribing mistakes (errors due to the correct execution of an incorrect plan). Knowledge-based mistakes (KBMs) appeared to arise from poor knowledge of practical aspects of prescribing such as dosing, whereas rule-based mistakes (RBMs) resulted from inappropriate application of knowledge. Multiple error-producing and latent conditions were described by participants for RBMs and KBMs. Poor/absent senior support and a fear of appearing incompetent occurred with KBMs. Following erroneous routines or seniors' orders were major contributory factors in RBMs.
  
  
  CONCLUSIONS
  Although individual factors such as knowledge and expertise played a role in prescribing mistakes, there were many perceived interrelated factors contributing to error. We conclude that multiple interventions are necessary to address these and further research is essential.
authors: Manchester Pharmacy School, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
authors: Penny J
authors: PJ
authors: Lewis
authors: Darren M
authors: DM
authors: Ashcroft
authors: Tim
authors: T
authors: Dornan
authors: David
authors: D
authors: Taylor
authors: Val
authors: V
authors: Wass
authors: Mary P
authors: MP
authors: Tully
mesh_terms: D002983:Clinical Competence; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008508:Medication Errors / Q000706:statistics & numerical data; D010820:Physicians / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D016526:Workload
keywords: critical incident technique; hospitalists; internship; medication errors; qualitative research