title: Improving feedback on junior doctors' prescribing errors: mixed-methods evaluation of a quality improvement project.
abstract: Prescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation.
  
  
  
  To reduce prescribing errors in a UK hospital by improving feedback on prescribing errors.
  
  
  
  We developed three linked interventions using plan-do-study-act cycles: (1) name stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to provide feedback to doctors on individual prescribing errors and (3) fortnightly prescribing advice emails that addressed a common and/or serious error.
  
  
  
  Interventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctors stated their name. Outcome measures were junior doctors' and pharmacists' perceptions of current feedback provision (evaluated using quantitative pre-questionnaires and post-questionnaires and qualitative focus groups) and the prevalence of erroneous medication orders written by junior doctors between August and December 2013.
  
  
  
  The percentage of medication orders for which junior doctors stated their name increased from about 10% to 50%. Questionnaire responses revealed a significant improvement in pharmacists' perceptions but no significant change for doctors. Focus group findings suggested increased doctor engagement with safe prescribing. Interrupted time series analysis showed no difference in weekly prescribing error rates between baseline and intervention periods, compared with the control site.
  
  
  
  Findings suggest improved experiences around feedback. However, attempts to produce a measurable reduction in prescribing errors are likely to need a multifaceted approach of which feedback should form part.
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Reynolds
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Seetal
authors.initials: S
authors.lastname: Jheeta
authors.affiliation: Centre for Patient Safety and Service Quality, Imperial College London, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benn
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.|Department of Pharmacy, London North West Healthcare NHS Trust, London, UK.
authors.forename: Inderjit
authors.initials: I
authors.lastname: Sanghera
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Jacklin
authors.affiliation: Royal College of Pathologists, London, UK.
authors.forename: Digby
authors.initials: D
authors.lastname: Ingle
authors.affiliation: Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK.|Centre for Patient Safety and Service Quality, Imperial College London, London, UK.|Department of Practice and Policy, UCL School of Pharmacy, London, UK.
authors.forename: Bryony Dean
authors.initials: BD
authors.lastname: Franklin
mesh_terms: D011307:Drug Prescriptions / Q000592:standards*; D000068156:Formative Feedback; D006801:Humans; D008505:Medical Staff, Hospital; D008508:Medication Errors / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: Audit and feedback; Medical education; Medication safety; Quality improvement