Nearly one in ten prescriptions written for hospital patients contains errors, with doctors relying heavily on pharmacists and nurses to correct mistakes, a study has found.
Pressure on doctors during busy ward rounds and a general lack of “safety culture” in the NHS is contributing to thousands of mistakes on the type or dose of medications ordered in hospitals every week.
Experienced staff typically act as a safety net to help catch mistakes by junior doctors before they can harm patients.
But the lack of consistent forms or charts for ordering and monitoring medicines increases the risk of patients coming to harm, the General Medical Council (GMC) said.
It called for a standardised prescription chart — the type that sits at the end of a patient’s hospital bed — to be introduced across Britain to reduce the number of errors.
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Across the NHS, about 100 patients die or suffer serious harm each year after being given the wrong medication.
The latest study, involving 19 hospital trusts in northwest England, found that over a seven-day period, 124,260 medication orders were checked by pharmacists, who detected 11,077 errors.
Among the errors, about one in eight were considered potentially lethal or serious cases — where drugs were prescribed to a patient who was allergic to them, or the wrong dose was ordered.
More than half of the errors (53 per cent) were considered “potentially significant”, including patients not being prescribed required medicines on admission or discharge from hospital, or during their stay.
The study, commissioned by the GMC, follows concerns that newly qualified doctors were more likely to make mistakes because they have not been trained to prescribe drugs properly. A recent poll of junior doctors found that three quarters felt they were putting patients at risk.
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But researchers at the University of Manchester found no evidence that junior doctors made more mistakes than those who have been in their jobs far longer.
In fact, those in the second year after graduating from medical school were the most likely to commit errors, making mistakes in 10.3 per cent of cases studied. The average rate of prescription errors for doctors of all grades was 8.9 per cent.
The GMC, which regulates medical training and practice, suggested this could be because doctors were asked to handle more complicated cases in their second year of full-time work.
A total of 50,016 orders were written by junior doctors in their first year after graduating, who made 4,190 mistakes (8.4 per cent).
In follow-up interviews with medical trainees, a lack of support over prescribing and reliance on other people to check for mistakes emerged as prominent themes.
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Some doctors described being in a rush, while other mistakes were routine. One trainee repeatedly wrote controlled drug descriptions incorrectly because he saw it as a minor error that would be corrected by the pharmacy.
The report adds: “A ‘safety culture’ was conspicuous by its absence from respondents’ discourses of their prescribing errors, the reported culture of their working environments and the reported actions of other doctors.
“Doctors relied heavily on pharmacists and nurses to identify and correct errors.”
The latest study comes after a report in September found that more than 86,000 incidents involving the prescription, administration or supply of medicines was reported to the NHS.
About 96 per cent of these incidents resulted in low or no harm to patients.
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The GMC said it was not aware of any patients who had come to harm because of the mistakes outlined in the study.
The Medical Schools Council said it supported the council’s call for a standard prescription chart.
Wales introduced such a chart in 2004, but elsewhere different charts are used.
Dave Roberts, chief pharmacist at the University Hospital of Wales in Cardiff, said: “Hospital drug charts allow doctors to prescribe up to 20 different medications over a two-week period. They are not exactly straightforward documents to follow.
“If individual hospitals all have their own different charts, in moving from one location to another, it’s almost like speaking a different language every time [doctors and pharmacists] change hospital.”
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Professor Peter Rubin, chairman of the GMC, said: “Prescribing decisions in a hospital setting often have to be made quickly, so it is important that a procedure is as simple as possible to minimise the chance of an error being made.”
The Department of Health said it would examine the evidence on standardised prescription charts. “Medical students have received increased training and experience in prescribing over the last two years. There is now more emphasis on prescribing skills in post-graduate studies,” it said.