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.
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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.