Risk assessment of prescribing errors on medical prescriptions in Malta and Germany

Abstract

Errors on a medical practitioner’s prescription may lead to erroneous dispensing by the pharmacist. A risk assessment of errors on medical prescriptions in Malta and Germany was undertaken. This study developed a comparative research method with the aim of (1) identifying and analysing the current status of processes that may lead to prescribing errors by prescribers and to pharmacist’s reduced detection of erroneous prescriptions and (2) assessing the risk of prescribing errors from a medical practitioner’s and pharmacist’s perspective. Interviews with medical practitioners were conducted in Malta and in Germany to identify root causes of prescribing errors. Interview results were used to develop two questionnaires, one for medical practitioners, entitled ‘Prescribing Error Questionnaire’ (PEQmed) and one for community pharmacists (PEQpharm). PEQmed and PEQpharm were validated by 16 experts using a two-round structured communication technique. The PEQmed and the PEQpharm consisted of two main sections. Section one analysed the current status of root causes by asking practitioners to rate selected causes of prescribing errors and pharmacists to rate the causes of reduced detection of prescribing errors. Section two asked participants to rate potential prescribing errors on a scale from 1 (low score) to 4 (high score) by their probability of occurrence and severity of consequences to get an overall ‘Risk Priority Number’ (RPN) (1 - 4 low risk) (6 medium risk) (8 - 16 high risk). The results showed that two hundred and four medical practitioners (104 Malta, 100 Germany) and 189 pharmacists (86 Malta, 103 Germany) answered the PEQmed and the PEQpharm respectively. Interruption rates while consulting with a patient as a root cause of prescribing errors showed a statistically significant difference among medical practitioners (p<0.001) with63 in Malta (66%) compared to 32 (32%) in Germany. The interruptions among community pharmacists also showed a statistically significant difference (p=0.02) with higher interruption rates in Malta (47%, n=40 Malta; 32%, n=33 Germany). Stress was indicated to be another root cause of prescribing errors within the medical practitioners’ group (75%, n=78 Malta; 67%, n=67 Germany) (p>0.05), whereas the group of pharmacists showed a statistically significant difference (p=0.02) with higher perceived stress in Malta (73%, n=63) compared to Germany (61%, n=63). Prescribing errors due to illegible handwriting (average RPN of 6.81 for medical practitioners, 7.95 for pharmacists) and the use of abbreviations (average RPN 5.29 medical practitioners; 5.81 pharmacists) were rated as the two most common risks among medical practitioners and pharmacists leading to potential dispensing errors in Malta. German medical practitioners’ and pharmacists’ most common risks were the omission of duration of use from the prescription and longer duration of short-term use drugs (average RPN 6.42 and 6.21 medical practitioners; 6.08 and 7.6 pharmacists, respectively). The awareness of medical practitioners and community pharmacists can be increased to avoid future errors. Specific risk minimisation strategies on the basis of identified prescribing error risk should be addressed to reduce risks in the specific country.