Which non-technical skills do junior doctors require to prescribe safely? A systematic review.
OBJECTIVE
Prescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings.


METHODS
A systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data.


RESULTS
A prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed.


CONCLUSIONS
This prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future.
Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh.
Effie
E
Dearden
Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh.
Edward
E
Mellanby
Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh.
Helen
H
Cameron
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
Jeni
J
Harden
D002983:Clinical Competence; D003657:Decision Making; D011307:Drug Prescriptions; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D010817:Physician-Patient Relations; D011785:Quality Assurance, Health Care
drug prescription; education; human factors; internship and residency; non-technical skills; patient safety