Error awareness to enhance paediatric prescribing amongst junior doctors: a novel evidence based educational strategy

Abstract

Aims Prescribing errors are one of the most common adverse events in healthcare, with those working in paediatrics at particular risk. Junior medical staff have also been identified as at risk of being involved in such errors, due to inexperience and their responsibility of 75% of inpatient orders. Whilst much research reports systems based approaches to enhance prescribing, there are few studies concerning the role of education1. Previous research in patient safety has highlighted the importance of error awareness education to enhance professional attitudes and reduce errors, although its effectiveness is poorly investigated2. In addition, it has been postulated that knowledge of errors, so called error wisdom, can improve mental preparedness and enhance skills. Feedback systems for errors are limited by their practicalities in a shift based working pattern and are often interpreted by junior staff as a blame culture. We set out to introduce anonymous departmental prescribing feedback to enhance error awareness and error wisdom and assess its impact on medication errors and patient safety attitudes. Methods The setting was an inpatient paediatric unit with 20 junior medical staff. A patient safety attitudes questionnaire (APSQ-II) was completed at baseline. A prospective medication chart review was undertaken on a fortnightly basis for 3 months. After each review, key data was presented in a poster, offering contemporaneous and anonymous feedback (figure 1). At completion, participants again completed the APSQ-II survey. Results After the completion of the 3 month feedback period, the percentage of trainee orders containing minor errors showed a statistically significant drop from 75.9% to 25.9% (p=0.007). At baseline, the mean APSQ-II score was 124.6 and post intervention the mean was 129.7, suggesting improved patient safety attitudes, although this result was not statistically significant. Conclusions This small study has demonstrated the potential utility of this simple and easy to introduce standalone form of education. It can enhance junior doctor paediatric prescribing, reduce errors and enhance attitudes. Although further research is needed, this study suggests the importance of error awareness as a part of any programme on patient safety education.