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Quality improvement report
Improving feedback on junior doctors’ prescribing errors: mixed-methods evaluation of a quality improvement project
  1. Matthew Reynolds1,
  2. Seetal Jheeta1,
  3. Jonathan Benn2,
  4. Inderjit Sanghera1,3,
  5. Ann Jacklin1,
  6. Digby Ingle4,
  7. Bryony Dean Franklin1,2,5
  1. 1Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
  2. 2Centre for Patient Safety and Service Quality, Imperial College London, London, UK
  3. 3Department of Pharmacy, London North West Healthcare NHS Trust, London, UK
  4. 4Royal College of Pathologists, London, UK
  5. 5Department of Practice and Policy, UCL School of Pharmacy, London, UK
  1. Correspondence to Professor Bryony Dean Franklin, Department of Practice and Policy, UCL School of Pharmacy, London, WC1N 1AX, UK; bryony.deanfranklin{at}imperial.nhs.uk

Abstract

Background 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.

Aim To reduce prescribing errors in a UK hospital by improving feedback on prescribing errors.

Interventions 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.

Implementation and evaluation 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.

Results 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.

Conclusion 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.

  • Audit and feedback
  • Quality improvement
  • Medical education
  • Medication safety

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjqs-2015-004717

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    Footnotes

    • This work was previously presented as the following conference abstracts. Reynolds M, Jheeta S, Benn J, Franklin BD. A Plan-Do-Study-Act approach to increasing the prevalence of prescribers’ names on individual inpatient medication orders. Poster presented at the Royal Pharmaceutical Society Annual Conference, 7–8 September 2014. Reynolds M, Jheeta S, Benn J, Franklin BD. Increasing the prevalence of junior doctor prescribers' names on individual inpatient medication orders Poster presented at International Forum on Quality and Safety in Healthcare, 21–24 April 2015.

    • Contributors The study was conceived by BDF, AJ, MR, DI and JB. SJ, MR and BDF collected the data. JB, SJ, MR, BDF and IS conducted the data analysis. All authors contributed to paper writing and have approved the final version."

    • Funding This project is part of the Health Foundation's Shine 2012 programme. The Health Foundation is an independent charity working to continuously improve the quality of healthcare in the UK. This paper represents independent work supported by the National Institute for Health Research (NIHR) Imperial Patient Safety Translational Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.