Prospective ongoing prescribing error feedback to enhance safety: a randomised controlled trial

Abstract

Background Prescribing errors are one of the most common adverse events in healthcare. Previous research in patient safety has highlighted the importance of error awareness education to enhance professional attitudes and reduce errors. Previously researched systems of contemporaneous prescribing feedback are limited by shift working. A pilot study investigating a ward-specific system of prospective ongoing prescribing error feedback to prescribers led to a significant reduction in errors. This study investigated the introduction of the system over several wards to reduce errors.
Methods A ward cluster randomised controlled trial was conducted in a UK teaching hospital, including all medical prescribers in four randomised inpatient ward areas. After an assessment of prescribing on each ward, a ward-specific
feedback document was prepared, giving general and anonymous feedback, and forwarded to all consented participants
in the intervention areas. The primary outcome was total prescribing order error rates; secondary outcome measures included clinical order error rates, technical order error rates and cost per error prevented.
Results A total of 1493 medication orders were assessed for errors. There was no difference in error rates at baseline
(32.4 vs 42.6%, p = 0.594). After the introduction of the prospective ongoing prescribing error feedback, there was
significant difference in the overall rates of error (64.8 vs 26.3%, p = 0.003). Similarly, there were statistically significant
differences in the rates of clinical error (p = 0.003) and technical error (p = 0.013) on completion. The modelled cost of errors prevented in the intervention wards was £2.56 per error.
Conclusions A simple process of prescribing error feedback, grounded in non-technical skills educational theory,
reduces prescribing errors within a hospital setting. This system is cost effective as well as requiring minimal
resource to instigate.