How frequent are prescribing errors and near misses among traditional and non-traditional prescribers and how are they experienced?

Background Nurses, midwives, health visitors, pharmacists, chiropodists and others have all begun to assume the role of prescriber of medicines. However, little work has been done comparing how effective these prescribers are in relation to the medical or traditional prescribers; and even less looking at the overall safety of prescribing in relation to errors and near misses. This study examines the safety element to prescribing and encompasses training to prescribe, prescribing in practice, support required, errors and near misses and the experience of both traditional and non-traditional practitioners. Methods Embedded single case study analysis was used which included three subunits; analysis of one year of reported errors and near misses, semistructured interviews with each group of prescribers and a review of archival records of prescribing. Prescriptions were analysed using a validated error tool and interviews were analysed using Colazzi's procedural steps (1978); all data were then reviewed using the Brunswikian lens model (Scholz & Tietje 2002). Results All prescribers wanted better initial prescribing education and continual updates once qualified. Non-traditional prescribers made fewer errors than traditional prescribers, though they do have a higher near miss rate than traditional prescribers. 3 Prescribers use a range of staff for support, though non-traditional prescribers are more likely to use their peer group. Traditional prescribers have a more relaxed attitude to mistakes. Prescribing staff do not trust the incident reporting system primarily since there is no useful feedback given which would improve prescribing practices. Conclusions The trust needs to work with educational institutions to improve prescribing training for all staff. They also need to ensure that there is some method available for all prescribers to be regularly updated or tested on their ability to prescribe. Errors or near miss incidents involving prescribing must be shared with all prescribers so that everyone can learn from them. This information is transferable to other, similar institutions.