What is the scale of prescribing errors committed by junior doctors? A systematic review

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Prescribing errors account for a substantial proportion of medication errors and cause the most significant problems. • There is a dearth of accurate information on the prevalence of prescribing errors, with estimates from 1 to 100% of all patients admitted to hospital. WHAT THIS STUDY ADDS • This review reports the wide ranges of error rates seen, which cannot be compared due to differences in methodology and error definitions used. • A well‐conducted study of prescribing errors by junior doctors using standard definitions and methodology is urgently needed to allow development and assessment of appropriate interventions. AIMS Prescribing errors are an important cause of patient safety incidents, generally considered to be made more frequently by junior doctors, but prevalence and causality are unclear. In order to inform the design of an educational intervention, a systematic review of the literature on prescribing errors made by junior doctors was undertaken. METHODS Searches were undertaken using the following databases: MEDLINE; EMBASE; Science and Social Sciences Citation Index; CINAHL; Health Management Information Consortium; PsychINFO; ISI Proceedings; The Proceedings of the British Pharmacological Society; Cochrane Library; National Research Register; Current Controlled Trials; and Index to Theses. Studies were selected if they reported prescribing errors committed by junior doctors in primary or secondary care, were in English, published since 1990 and undertaken in Western Europe, North America or Australasia. RESULTS Twenty‐four studies meeting the inclusion criteria were identified. The range of error rates was 2–514 per 1000 items prescribed and 4.2–82% of patients or charts reviewed. Considerable variation was seen in design, methods, error definitions and error rates reported. CONCLUSIONS The review reveals a widespread problem that does not appear to be associated with different training models, healthcare systems or infrastructure. There was a range of designs, methods, error definitions and error rates, making meaningful conclusions difficult. No definitive study of prescribing errors has yet been conducted, and is urgently needed to provide reliable baseline data for interventions aimed at reducing errors. It is vital that future research is well constructed and generalizable using standard definitions and methods.