The prevalence and nature of prescribing and monitoring errors in English general practice : a retrospective case note review

Abstract

Objective To determine the prevalence and nature of prescribing and monitoring errors in general practices in the England. Design Retrospective case note review of unique medication items prescribed over a 12 month period to a 2% random sample of patients. Mixed effects logistic regression was used to analyse the data. Setting Fifteen general practices across three primary care trusts in England. Data sources Examination of 6048 unique prescription items prescribed over the previous 12 months for 1767 patients. Main outcome measures Prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval 4.4 - 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, factors associated with an increased risk of prescribing or monitoring errors in patients were: age less than 15 (1.81, 1.15 to 2.85, p=0.010) or greater than 64 years (1.67, 1.03 to 2.71, p=0.037), and higher numbers of unique medication items prescribed (1.16, 1.12 to 1.19, p<0.001). By contrast, women were less likely than men to have a prescribing or monitoring error (0.65, 0.47 to 0.90, p=0.010). At the prescription item level there was an increased risk of prescribing or monitoring errors for medications used in cardiovascular disease; infections; malignant disease and immunosuppression; musculoskeletal conditions; eye, ear nose and oropharynx, and skin conditions. Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, this will help in devising effective strategies for preventing errors in the future.