The causes of prescribing errors in English general practices: a qualitative study.

BACKGROUND Few detailed studies exist of the underlying causes of prescribing errors in the UK. AIM To examine the causes of prescribing and monitoring errors in general practice and provide recommendations for how they may be overcome. DESIGN AND SETTING Qualitative interview and focus group study with purposive sampling of English general practices. METHOD General practice staff from 15 general practices across three PCTs in England participated in a combination of semi-structured interviews (n = 34) and six focus groups (n = 46). Thematic analysis informed by Reason's Accident Causation Model was used. RESULTS Seven categories of high-level error-producing conditions were identified: the prescriber, the patient, the team, the working environment, the task, the computer system, and the primary-secondary care interface. These were broken down to reveal various error-producing conditions: the prescriber's therapeutic training, drug knowledge and experience, knowledge of the patient, perception of risk, and their physical and emotional health; the patient's characteristics and the complexity of the individual clinical case; the importance of feeling comfortable within the practice team was highlighted, as well as the safety implications of GPs signing prescriptions generated by nurses when they had not seen the patient for themselves; the working environment with its extensive workload, time pressures, and interruptions; and computer-related issues associated with mis-selecting drugs from electronic pick-lists and overriding alerts were all highlighted as possible causes of prescribing errors and were often interconnected. CONCLUSION Complex underlying causes of prescribing and monitoring errors in general practices were highlighted, several of which are amenable to intervention.