title: Improving specialist drug prescribing in primary care using task and error analysis: an observational study.
abstract: BACKGROUND
  Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs.
  
  
  OBJECTIVE
  To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS.
  
  
  METHODS
  Semi-structured interviews with key informants followed by an observational study involving GPs in the UK.
  
  
  METHODS
  Twelve key informants were interviewed to investigate the use of CDSSs in the UK. Nine GPs were observed while performing case scenarios depicting requests from hospitals or patients to prescribe a specialist drug. Activity diagrams, hierarchical task analysis, and systematic human error reduction and prediction approach analyses were performed.
  
  
  RESULTS
  The current process of prescribing specialist drugs by GPs is prone to error. Errors of omission due to lack of information were the most common errors, which could potentially result in a GP prescribing a specialist drug that should only be prescribed in hospitals, or prescribing a specialist drug without reference to a shared care protocol. Half of all possible errors in the prescribing process had a high probability of occurrence.
  
  
  CONCLUSIONS
  A CDSS supporting GPs during the process of prescribing specialist drugs is needed. This could, first, support the decision making of whether or not to undertake prescribing, and, second, provide drug-specific parameters linked to shared care protocols, which could reduce the errors identified and increase patient safety.
authors.affiliation: NHS Richmond Clinical Commissioning Group, Twickenham, London.
authors.forename: Narinder
authors.initials: N
authors.lastname: Chana
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Talya
authors.initials: T
authors.lastname: Porat
authors.affiliation: School of Medicine, Pharmacy and Health, Durham University, Durham.
authors.forename: Cate
authors.initials: C
authors.lastname: Whittlesea
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London.
authors.forename: Brendan
authors.initials: B
authors.lastname: Delaney
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making; D020000:Decision Support Systems, Clinical; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D061214:Patient Safety / Q000592:standards; D004364:Pharmaceutical Preparations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D058996:Quality Improvement; D006113:United Kingdom
chemical_list: D004364:Pharmaceutical Preparations
keywords: clinical decision support system; drug prescribing; general practice; primary health care; specialist drugs