Lewis Penny J, Ashcroft Darren M, Dornan Tim, Taylor David, Wass Val, Tully Mary P
Manchester Pharmacy School, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Br J Clin Pharmacol. 2014 Aug;78(2):310-9. doi: 10.1111/bcp.12332.
Prescribing errors are common and can be detrimental to patient care and costly. Junior doctors are more likely than consultants to make a prescribing error, yet there is only limited research into the causes of errors. The aim of this study was to explore the causes of prescribing mistakes made by doctors in their first year post graduation.
As part of the EQUIP study, interviews using the critical incident technique were carried out with 30 newly qualified doctors. Participants were asked to discuss in detail any prescribing errors they had made. Participants were purposely sampled across a range of medical schools (18) and hospitals (15). A constant comparison approach was taken to analysis and Reason's model of accident causation was used to present the data.
More than half the errors discussed were prescribing mistakes (errors due to the correct execution of an incorrect plan). Knowledge-based mistakes (KBMs) appeared to arise from poor knowledge of practical aspects of prescribing such as dosing, whereas rule-based mistakes (RBMs) resulted from inappropriate application of knowledge. Multiple error-producing and latent conditions were described by participants for RBMs and KBMs. Poor/absent senior support and a fear of appearing incompetent occurred with KBMs. Following erroneous routines or seniors' orders were major contributory factors in RBMs.
Although individual factors such as knowledge and expertise played a role in prescribing mistakes, there were many perceived interrelated factors contributing to error. We conclude that multiple interventions are necessary to address these and further research is essential.
处方错误很常见，可能对患者护理有害且成本高昂。初级医生比顾问医生更有可能犯处方错误，但对错误原因的研究却很有限。本研究的目的是探讨医生毕业后第一年所犯处方错误的原因。
作为EQUIP研究的一部分，采用关键事件技术对30名新获得资格的医生进行了访谈。参与者被要求详细讨论他们所犯的任何处方错误。参与者是从一系列医学院校（18所）和医院（15所）中有意抽取的。采用持续比较法进行分析，并使用Reason事故因果模型来呈现数据。
讨论的错误中超过一半是处方失误（因执行错误计划正确而导致的错误）。基于知识的错误（KBMs）似乎源于对处方实际方面（如剂量）的知识匮乏，而基于规则的错误（RBMs）则是由于知识应用不当所致。参与者描述了RBMs和KBMs的多种错误产生和潜在条件。KBMs出现时，上级支持不足/缺乏以及害怕显得不称职。遵循错误的常规做法或上级命令是RBMs的主要促成因素。
虽然知识和专业技能等个体因素在处方错误中起了作用，但有许多相互关联的因素被认为导致了错误。我们得出结论，需要采取多种干预措施来解决这些问题，进一步的研究至关重要。
