Pharmacist-led feedback for prescribers cuts errors in hospital, study suggests

Research carried out at a teaching hospital in the north-west of England finds that a feedback intervention effectively reduced prescribing errors.

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A pharmacist-led feedback intervention, aimed at supporting prescribers, resulted in a significant reduction in prescribing errors in hospital, a study in Research in Social and Administrative Pharmacy has demonstrated.

The researchers carried out a prospective prescribing audit across 16 hospital wards in a UK teaching hospital in the north-west of England over a five-day period. The intervention group, of 36 prescribers, received pharmacist-led, individualised constructive feedback on their prescribing, while the control group, of 41 prescribers, continued with existing practice.

Any errors were classified according to one of ten types and assigned a severity level — minor, significant, serious or potentially lethal.

Feedback, which took around ten minutes per prescriber, contained details on the number of items reviewed, errors identified and overall error rate, with examples provided and a section to record an agreed action plan to improve practice. This was then followed by further ongoing verbal and written feedback for any individual prescribing error classified as significant or greater, to encourage ongoing reflection on prescribing behaviour.

Prescribing was then re-audited after three months.

In total, 5,191 prescribed medications were audited at baseline, and 5,122 post-intervention. In the intervention group, the mean prescribing error rate reduced from 25% (standard deviation [SD] 16.8, 95% confidence interval [CI] 19.3–30.7) at baseline to 6.7% (SD 9.0, 95% CI 3.7–9.8) post-intervention.

In the control group, the baseline mean prescribing error rate was 25.1% (SD 17.0, 95% CI 19.8–30.6) at baseline and 23.7% (SD 3.5, 95% CI 30.6–16.8), post-intervention.

According to the researchers, the frequency of each error type and severity rating was reduced in the intervention group, while the error frequency of some error types and severity was seen to increase in the control group.

Overall, they concluded that, with calls for prescribing feedback to support junior doctors, the pharmacy-led feedback intervention had potential for wider adoption to optimise prescribing outcomes and patient safety.

Alice Oborne, consultant pharmacist in safe medication practice and medicines safety officer at Guy’s and St Thomas’ NHS Foundation Trust, said that the study showed that prescribers benefited from support and feedback on safe prescribing and understanding of the non-clinical factors that contribute to error.

“The findings confirm previous reports that prescribers are often unaware of their prescribing errors, and ward-based pharmacist services improve the quality and safety of prescribing,” she said.

“Inclusion of error causation theory and circumstances linked to error may result in a more global effect on medicines error than narrow feedback on a clinical error.”

However, Oborne highlighted that giving individualised feedback to prescribers was resource-intensive and could be “unsustainable”.

“The work was conducted in an organisation using paper prescriptions and many hospital trusts are implementing electronic prescribing systems.

“E-prescribing (rather than paper-based prescribing) is likely to affect the frequency, type and severity of error; for example, many e-systems ‘design out’ prescribing allergy and drug interaction errors, as well as legibility and prescription writing errors.

“In addition, electronic solutions to reduce errors in prescribing using electronic media may be less resource intensive to deliver than individualised feedback.”

Oborne added that, increasingly, the task of safe, effective prescribing was a collaboration between pharmacists and medical staff, both at the individual prescription level and progressing error wisdom and a culture of mediation safety.

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Citation
The Pharmaceutical Journal, December 2020;Online:DOI:10.1211/PJ.2020.20208679