Research into practice: safe prescribing.

British Journal of General Practice, May 2014 259 pRevalenCe, natuRe, and Causes of pResCRIbIng eRRoRs In geneRal pRaCtICe Over the past 10 years our team has been involved in a wide range of studies of prescribing in general practice, but one we feel that has really made a difference is the PRACtICe study, which was funded by the General Medical Council.1,2 In this study we took a sample of 15 general practices across England and did a retrospective review of the clinical records of a random sample of over 1700 patients, and over 6000 prescription items. Using a definition of error that focused on clinically important problems,1 we found that one in 20 (5%) prescription items was associated with one or more prescribing or monitoring errors, and that one in 550 prescription items contained what we regarded as a severe error1 (with seriously inadequate monitoring of patients taking warfarin the biggest culprit). We found that per prescription item, errors were more common in children and older people, and that nearly half of patients receiving >10 items over the course of a year were the recipients of an error. The commonest types of error related to incomplete information on the prescription, dose-strength errors, and timing-frequency errors. Using interviews, root cause analyses and focus groups, we explored the underlying causes of the errors and, not surprisingly, found them to be multifactorial.2 Of the various underlying causes, we felt that several were amenable to intervention, including improving safety systems in general practices; making best use of our electronic prescribing systems, including computerised clinical decision support; improving prescribing and monitoring at the interface between primary and secondary care, and better training for GPs in therapeutics and safe prescribing (accepting that most GPs already have good therapeutic knowledge and are highly committed to patient safety). We made a number of recommendations from our research and have taken several of these forward as described later in this article, and in Box 1.