title: Prevalence, nature and predictors of prescribing errors in mental health hospitals: a prospective multicentre study.
abstract: OBJECTIVE
  To determine the prevalence, nature and predictors of prescribing errors (PEs) in three mental health hospitals.
  
  
  METHODS
  Inpatient units in three National Health Service (NHS) mental health hospitals in the North West of England.
  
  
  METHODS
  Trained clinical pharmacists prospectively recorded the number of PEs in newly written or omitted prescription items screened during their routine work on 10 data collection days. A multidisciplinary panel reviewed PE data using established methods to confirm (1) the presence of a PE, (2) the type of PE and (3) whether errors were clinically relevant and likely to cause harm.
  
  
  METHODS
  Frequency, nature and predictors of PEs.
  
  
  RESULTS
  Of 4427 screened prescription items, 281 were found to have one or more PEs (error rate 6.3% (95% CI 5.6 to 7.1%)). Multivariate analysis revealed that specialty trainees (OR 1.23 (1.01 to 1.51)) and staff grade psychiatrists (OR 1.50 (1.05 to 2.13)) were more likely to make PEs when compared to foundation year (FY) one doctors, and that specialty trainees and consultant psychiatrists were twice as likely to make clinically relevant PEs (OR 2.61 (2.11 to 3.22) and 2.03 (1.66 to 2.50), respectively) compared to FY one staff. Prescription items screened during the prescription chart rewrite (OR 0.52 (0.33 to 0.82)) or at discharge (OR 0.87 (0.79 to 0.97)) were less likely to be associated with PEs than items assessed during inpatient stay, although they were more likely to be associated with clinically relevant PEs (OR 2.27 (1.72 to 2.99) and 4.23 (3.68 to 4.87), respectively). Prescription items screened at hospital admission were five times more likely (OR 5.39 (2.72 to 10.69)) to be associated with clinically relevant errors than those screened during patient stay.
  
  
  CONCLUSIONS
  PEs may be more common in mental health hospitals than previously reported and important targets to minimise these errors have been identified.
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Keers
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK Pharmacy Department, University Hospital of South Manchester NHS Foundation Trust, MAHSC, Manchester, UK.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Williams
authors.affiliation: Adult Services Warrington, 5 Boroughs Partnership NHS Foundation Trust, Warrington, Cheshire, UK Medical School, University of Liverpool, Liverpool, UK.
authors.forename: Joe J
authors.initials: JJ
authors.lastname: Vattakatuchery
authors.affiliation: Pharmacy Department, Manchester Mental Health and Social Care NHS Trust, MAHSC, Manchester, UK.
authors.forename: Petra
authors.initials: P
authors.lastname: Brown
authors.affiliation: Pharmacy Department, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK.
authors.forename: Joan
authors.initials: J
authors.lastname: Miller
authors.affiliation: Medicines Management Team, 5 Boroughs Partnership NHS Foundation Trust, Warrington, Cheshire, UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Prescott
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
mesh_terms: D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000188:drug therapy; D015995:Prevalence; D011446:Prospective Studies; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs
keywords: PSYCHIATRY