More care and attention must be paid to every prescription written

December 10, 2009

Following the release of the EQUIP (Errors--Questioning Undergraduate Impact on Prescribing) study on the website of the UK's General Medical Council, the lead Editorial in this week's Lancet says that prescribing and pharmacology training must improve, so that more care and attention is paid to every prescription written.

EQUIP looked at 124 260 prescriptions in 19 hospitals in northwest England over 7 days. 11 077 contained errors--an error rate of 8•9%. When considered by level of training, the error rate was 8•4% for foundation year 1* compared with 10•3% for foundation year 2* doctors, 8•3% for those in fixed-term specialty training posts, and 5•9% for consultants. 1•7% of errors were potentially lethal. Nearly all errors were detected by pharmacists, nurses, or by other doctors before the medicines were dispensed to patients.

Tim Dornan and colleagues, the EQUIP study authors, make several suggestions to improve matters, include changing clinical working environments, and undergraduate and postgraduate education. Introduction of a standard drug chart throughout the National Health Service would, say Dornan and colleagues, reduce errors--such a chart has been used across Wales since 2004, but no study has yet been done into whether this standard chart has reduced prescribing errors.

Dornan and colleagues add that it is also important to build a "safety culture" into clinical practice. They recommend that undergraduate medical education programmes increase their practical prescribing components including prescribing under supervision during student assistantships.

The Editorial says: "What is shocking about the error rates released by the GMC is that almost one in ten hospital prescriptions were wrong. What is surprising, perhaps, is that the error rate for consultants was as high as one in 20, and that the most junior doctors were no worse than the average."

Kent Woods, Chief Executive for the UK's Medicines and Healthcare products Regulatory Agency, told The Lancet that "teaching of clinical pharmacology and therapeutics is patchy across medical schools and in some has declined to an unacceptable level".

The Editorial says: "Clinical pharmacologists are well placed to teach medical students and postgraduate doctors, but pharmacists too have a key educational role to play."

It concludes: "Therapeutics--the practical application of pharmacology to the prevention, treatment, and alleviation of disease--needs to become part of every doctor's undergraduate training and continuing professional development. Sustained on-the-job interprofessional training would help to remind doctors of best prescribing practices. A safety culture must become the norm, with more care and attention paid to every prescription written."
For full Editorial, see:

Note to editors: *Foundations years 1 and 2 for UK doctors represent their first 2 years after leaving medical school


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