Alterations in pharmacy practice from prescription dispensing to more patient-centered relationship intensifies the necessity of clinical decision-making. Pharmacists’ knowledge as well as ethical reasoning affects their clinical decision-making. Unfortunately in Iran pharmacy ethics did not develop along with medical ethics and special considerations are of major importance. The study was designed to evaluate pharmacists’ attitude toward some principles of bioethics.
A cross-sectional survey was performed on a sample of Iranian pharmacists attended in continuous education programs in 2010. Based on the pharmacists’ attitude toward common ethical problems, 9 Likert-type scale scenarios were designed. A thousand pharmacists were surveyed and 505 questionnaires were filled. For the whole questionnaire the strongly disagree answer was the most ethical answer. On a scale from 1–5 on which 5=strongly disagree, the total score of pharmacists ethical attitude was 17.69 ± 3.57. For easier analysis we considered the score of 1 for agree and strongly agree answers, score of 2 for neutral answers and score of 3 for disagree and strongly disagree answers. The total score in confidentiality for all participants was 4.15 ± 1.45 out of 9, in autonomy 6.25 ± 1.85 out of 9, in non-maleficence 5.14 ± 1.17 out of 6 and in justice was 2.27 ± 0.89 out of 3, however there was no significant difference between men and women in the total score and the score of each theme. The older participants (> 40 years) significantly had lower total score (P< 0.05) as well as the score of each theme (P< 0.05), except for non-maleficence. The work experience showed impact on the pharmacists’ attitude toward autonomy and the participants with more than 5 years work experience significantly obtained lower score in this theme.
Compiling ethical guidelines and improving pharmacy ethics curriculum is highly critical to provide the best pharmaceutical care and to make clinical decisions in critical situations. Therefore further quantitative and qualitative investigations into finding pitfalls and challenges in this issue are highly recommended.
Pharmacy ethics; Ethical attitude; Confidentiality; Autonomy
Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.
Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency.
Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy.
Conducting research in the home setting with home-bound older adults presents distinct ethical and practical challenges that require special consideration. This article describes the methodological issues that make studying homebound older adults especially vulnerable to therapeutic misconception and researcher role conflict and offers practical strategies for researchers to deal with these problems when studying this population. In writing this article, we draw on more than a decade of descriptive and intervention research focusing exclusively on the homebound older population in which the authors have collaborated. Therapeutic misconception and researcher role conflict may occur because of methodological issues related to the recruitment of participants, the “homebound” status of participants, and the home setting as the interview site. Particular care is required on the part of the researcher to address these ethical issues. This may be accomplished especially through clear communication during the informed consent process with participants and in scientific communication with colleagues.
Research ethics; Homebound elders; Therapeutic misconception; Role conflict
The described interdisciplinary course helped a mixed population of in-service secondary English and biology teacher-participants increase their genetics content knowledge and awareness of Ethical, Legal, and Social Implications (ELSI) that arose from discoveries and practices associated with the Human Genome Project. This was accomplished by applying a critical literacy approach that allows people develop cognitive skills such that they are able to “read the world” (Wink, 2004). The approach is one that permits readers to go beyond the literal text to examine what is present as well as what is missing as it relates to issues of equity and fairness. Becoming critically literate enabled these teacher-participants to challenge the subtle attitudes, values, and beliefs conveyed by a range of written and oral texts. The teacher-participants in this course improved their critical literacy skills by actively reading, critically writing about, and using evidence to support their conclusions about issues arising from advances in human genetics. A biologist, a linguist, and an educator collaboratively designed and taught the course. The personalized focus on the integration of thoughtful reading and writing in this class enhanced the teacher-participants' (n = 16) professional and intellectual development and will potentially improve learning in their biology and English classrooms in the future.
Ethics does not seem to be a favorite topic of Indian authors. Electronic search of the IJP web site could only identify six articles which were directly related to ethics. One article discussed the relationship of ethics religion and psychiatry. Another editorial discussed the concept of responsibility in psychiatrists. Other editorial discussed the truth about ‘truth serum’ in legal investigations. One article discussed the ethical aspects of published research. There were two articles that specifically discussed ethical aspects. This write-up provides some details about the ethical aspects of psychiatric practice, specific to India, and emphasizes the need to rediscover ethics in India.
Ethics; Psychiatry; India
This paper responds to the question: Do physicians have an ethical obligation to care for patients with acquired immunodeficiency syndrome (AIDS)? First, the social and political milieu in which this question arises is sampled. Here physicians as well as other members of the community are found declaring an unwillingness to be exposed to people with AIDS. Next, laws, regulations, ethical codes and principles, and the history of the practice of medicine are examined, and the literature as it pertains to these areas is reviewed. The obligation to care for patients with AIDS, however, cannot be located in an orientation to morality defined in rules and codes and an appeal to legalistic fairness. By turning to the orientation to morality that emerges naturally from connection and is defined in caring, the physicians' ethical obligation to care for patients with AIDS is found. Through an exploration of the writings of modern medical ethicists, it is clear that the purpose of the practice of medicine is healing, which can only be accomplished in relationship to the patient. It is in relationship to patients that the physician has the opportunity for self-realization. In fact, the physician is physician in relationship to patients and only to the extent that he or she acts virtuously by being morally responsible for and to those patients. Not to do so diminishes the physician's ethical ideal, a vision of the physician as good physician, which has consequences for the physician's capacity to care and for the practice of medicine.
This paper examines the attempts to develop and implement an ethics curriculum for the Internal Medicine Residency Program at the University of Maryland Medical Center. The objectives of the curriculum were to enhance moral reasoning skills and to promote humanistic attitudes and behavior among the residents. The diverse methodologies used to achieve these objectives included case discussions, literature reading, role playing, writing, and videos. These activities occurred predominantly within the forum of morning report sessions and ethics ward rounds. The author also describes efforts to overcome the initial constraints associated with the implementation of this curriculum and concludes by exploring future directions for the curriculum.
There is a growing body of writing, for instance from the nursing profession, espousing an approach to ethics based on care. I suggest that this approach is hopelessly vague and that the vagueness is due to an inadequate analysis of the concept of care. An analysis of 'care' and related terms suggests that care is morally neutral. Caring is not good in itself, but only when it is for the right things and expressed in the right way. 'Caring' ethics assumes wrongly that caring is good, thus it can tell us neither what constitutes those right things, nor what constitutes the right way.
The potential role of the psychotherapist as ethical interventionist is considered with reference to a patient who presented with a writing block. The case for the therapist to act paternalistically is followed by the counterargument which revolves around the respect for autonomy. A bridge between these two opposing positions is then offered which depends on viewing informed consent as a dynamic process. As part of this procedure it is made clear that while autonomy is the desired end-state of psychotherapy, it is not the be all and end all of treatment. Therapy is necessarily value-laden since it aims for the enhancement of the patient's state of autonomy; it is value-free inasmuch as the therapist desists from guiding the patient in how she should live her life.
Ayurveda, the ancient Indian “Science of Life” and age – old traditional medical science of India, has a recorded history of more than 2000 years. During this period certain changes and developments occurred in the conceptual framework of this science as well as in the political, socio – economic, and religion contexts in which Ayurvedic science must be seen. In his historical process one observes a continuous systematization, diversification, and specialization of the science.
Yet, among the central concerns of Ayurveda has always been promotion and maintenance of health and prevention of disease. Especially on the first topic one finds beautiful expositions in the early samhitas of Ayurvedic writing. But there is hardly any further elaboration on this subject in the later literature and until today. “It's all been said in Caraka”.
As the importance of health promotion and prevention medicine for comprehensive health care is now recognised, what is required today are not flat statements such as “Ayurveda is prevention in itself” but a critical assessment of the respective issues of Ayurvedic or any other old tradtion with a view to their relevance today, with a clear sigth of their limitations, and without loosing out of sight the ways and means required for their implementations.
The frequency of drug prescription errors is high. Excluding errors in decision making, the remaining are mainly due to order ambiguity, non standard nomenclature and writing illegibility. The aim of this study is to analyse, as a part of a continuous quality improvement program, the quality of prescriptions writing for antibiotics, in an Italian University Hospital as a risk factor for prescription errors.
The point prevalence survey, carried out in May 26–30 2008, involved 41 inpatient Units. Every parenteral or oral antibiotic prescription was analysed for legibility (generic or brand drug name, dose, frequency of administration) and completeness (generic or brand name, dose, frequency of administration, route of administration, date of prescription and signature of the prescriber). Eight doctors (residents in Hygiene and Preventive Medicine) and two pharmacists performed the survey by reviewing the clinical records of medical, surgical or intensive care section inpatients. The antibiotics drug category was chosen because its use is widespread in the setting considered.
Out of 756 inpatients included in the study, 408 antibiotic prescriptions were found in 298 patients (mean prescriptions per patient 1.4; SD ± 0.6). Overall 92.7% (38/41) of the Units had at least one patient with antibiotic prescription. Legibility was in compliance with 78.9% of generic or brand names, 69.4% of doses, 80.1% of frequency of administration, whereas completeness was fulfilled for 95.6% of generic or brand names, 76.7% of doses, 83.6% of frequency of administration, 87% of routes of administration, 43.9% of dates of prescription and 33.3% of physician's signature. Overall 23.9% of prescriptions were illegible and 29.9% of prescriptions were incomplete. Legibility and completeness are higher in unusual drugs prescriptions.
The Intensive Care Section performed best as far as quality of prescription writing was concerned when compared with the Medical and Surgical Sections.
Nevertheless the overall illegibility and incompleteness (above 20%) are unacceptably high. Values need to be improved by enhancing the safety culture and in particular the awareness of the professionals on the consequences that a bad prescription writing can produce.
Dyslexia is one of the commonest learning disability. It is defined as a disorder where a child, in spite of all the classroom teaching, is not able to attain the language skills of reading, writing and spelling according to their level of intelligence. Dyslexia individuals often have difficulty in relating to the association between sound and their respective letters. Reversing or transposing the letters while writing is characteristic with letters such as b and d, P and q, etc., The prevalence among school children is reported as 9.87% and in the selected families, it is 28.32%. Dyslexia significantly interferes with academic achievement or activities of daily life and are not primarily due to sensory, motor or mentally handicaps. About 40% of dyslexic children and adolescents dropout of schools. According to Ayurveda, learning is a result of successive and complex interaction of Indriyas (cognitive and motor organs), Indriyartha (sense organs), Mana (psyche), Atma and Buddhi (intellect). Above all, the functioning of these factors is governed by Tridosha (vata, pitta and kapha) and Triguna (Sattva, Raja and Tama) in a specific coordination and balance Any disturbance in these Tridosha and Triguna will cause disordered functioning of Indriya, Mana and Buddhi leading to impaired learning or Dyslexia Ayurvedic drugs can help in the management of dyslexia by making these Tridosha and Triguna in well-balanced state and also by providing Medhya (intellect promoting) drugs to improve the learning ability in these children.
Ayurveda; dyslexia; Medhya; Tridosha; Triguna
Ethical problems often revolve around the conflicts of the models of beneficence and autonomy. Adolescents present a particular complication in their own struggle for autonomy. The physician is confronted with the further dilemma of sorting out the role of parents and the role of the adolescent patient in decision making. Furthermore, as adolescents develop their own moral code, they may lack consistency in their actions and opinions. The physician must examine the total context in arriving at a decision. The prescription of contraception is taken as an example of a common ethical dilemma.
adolescents; contraception; abortion; decision making
Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under‐researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy—one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under‐researched discipline.
Drug safety is not a matter for healthcare professionals alone. As actors, patients are also concerned, at three different levels: 1) with regard to their behaviour and choices of drugs, with a view to reducing adverse reactions, 2) with regard to the discourse sometimes used by doctors in relation to prescribed drugs, 3) with regard to the discourses of the pharmaceutical industry concerning how they use their drugs within the framework of self-medication. We will examine these aspects on the basis of data gathered in France during anthropological studies on drug use.
Patients’ concerns about reducing adverse effects give rise to a series of behaviours relating to drug use. They start with the identification of what they regard as a risk inherent in the substances or linked to uncontrolled use of drugs and try to neutralize their risks by modifying or modulating the prescriptions in line with various parameters. They take into account dimensions as varied as: the nature of the prescribed drugs, the quantity, the dosage and the preservation of certain functions or organs, and follow their own rules of conduct in order to reduce risks. These dimensions bring into play both representations of the drug and representations of the person, and consider the effects or the risks of drugs in their physical, psychic, behavioural and social aspects.We consider here doctors’ discourse towards patients regarding the risks and possible effects of drugs, in particular the discourse of those who choose to hide the undesirable effects of drugs from their patients – or even to lie to them on this subject – with the aim of not jeopardizing the patient’s compliance. This situation involves comparing two logics: ethics of care versus ethics of information.Regarding the pharmaceutical industry’s discourse on self-medication and risks. Although it promotes self-medication on the basis of patients’ growing desire for autonomy and competency, the pharmaceutical industry has a discourse which stigmatizes the home medicine cabinet for reasons of safety, which in fact questions patients’ ability to use drugs properly.
This analysis shows that the various behaviours and discourses relating to the risks of drugs are impregnated with symbolic, ethical and cultural logics. As a consequence, above and beyond works carried out on the question of pharmacovigilance, examining the issue of safe drug use involves studying the human (social and cultural) aspects which govern part of the discourses and practices relating to drug safety.
Drug Industry; ethics; Drug Therapy; adverse effects; ethics; Humans; Patient Participation; methods; Physician-Patient Relations; ethics; drug safety; self-medication; risk; doctor-patient relationship; information; pharmaceutical industry; cultural behaviour; ethics
Last decade has witnessed a spurt in articles focused on the topic of evidence-based medicine (EBM) and medical ethics. These articles are not only educative, but draw attention to the changing scenario of medical practice. Surgeons seem a bit less attentive to practice of EBM, more so in the developing world. The theme is now percolating in our realm for demonstrable incorporation of EBM in our practice, which is allegorical of a good physician and is also likely to become demanding legally. In practicing EBM, several conflicts may arise with the ethical vows of medicine. However, majority of these conflicting issues have germinated from a capitalistic approach to medical practice, where the fear of extraneous compulsions dictating prescriptions and procedures in the garb of ‘evidence-based practice’ conflicts ethical behaviour. This review shall appraise the reader with important definitions of medical ethics, EBM and how to incorporate best evidence into ones practice. While, EBM brings objectivity to treatment to derive measurable outcomes it should not become regimented or metamorphose as a pseudonym for defensive medicine to escalate treatment costs. EBM also has several limitations one of which is to place the onus on the practicing physician to search for the best evidence and the other is the resource constraint of practice in the developing world. How a plastic surgery practice could be made to conform to evidence based (EB) procedures is proposed as insufficient surgical skills can pose a serious threat to not only the practice of EB procedures, but to ethical responsibilities as well. In conclusion, it is necessary to incorporate ethical temperance into EB procedures to withstand societal, peer and legal pressures of current times.
Ethics; evidence-based medicine; evidence-based practice; medical ethics
General practitioners write the vast majority of the 190 million prescriptions issued annually in Canada. The author reviewed the English language literature to determine the general characteristics of that prescribing, the appropriateness of prescribing, and factors that influence prescribing. On average, GPs write one prescription for every two office visits. Each prescription is for 1.2 to 1.4 items. Most of any GP's prescriptions are for a group of fewer than 30 different medications. Factors that influence prescribing include generic prescribing and knowledge of drug contents, provincial drug programs, physician and patient characteristics, type of practice, source of information about drugs, and rapidity of adoption of new drugs. The author offers suggestions for improving prescribing.
antibiotics; family medicine; pharmaceutic therapy; prescribing; psychotropic agents
Abstract Objective: To measure the effect of computer-based
outpatient prescription writing by internal medicine physicians on pharmacist
Design: Work sampling at a hospital-based outpatient pharmacy. Data
were collected from pharmacists wearing silent, random-signal generators
before and after the implementation of computer-based prescribing.
Measurements: The type of work performed by pharmacists (activity),
the reason for their work (function), and the people they contacted (contact)
Results: Total staff hours and prescriptions handled were similar
before and after computer-based prescribing. Pharmacists recorded 4,687
observations before and 4,735 observations after implementation of
computer-based outpatient prescription writing. After implementation,
pharmacists spent 12.9 percent more time correcting prescription problems, had
3.9 percent less idle time, and spent 2.2 percent less time in discussions
with others. Pharmacists also spent 34.0 percent less time filling
prescriptions, 45.8 percent more time in problem-solving activities involving
prescriptions, and 3.4 percent less time providing advice. Over 80 percent of
pharmacist time was spent working alone both before and after computer-based
outpatient prescription writing.
Conclusion: Computer-based prescribing results in major changes in
the type of work done by hospital-based outpatient pharmacists and in the
reason for their work and small changes in the people contacted during their
Oncology clinicians readily accepted features designed to enhance oral chemotherapy safety. Additional enhancements are needed to facilitate prescriptions with complex dosing regimens.
To prevent oral chemotherapy prescription errors, we enhanced a prescription-writing module in an ambulatory electronic medical record. We sought to describe the enhancement, examine its performance to date, and identify opportunities for improvement.
Enhancements to the oral chemotherapy writing module included weight- and body surface area–based dosing, fields for cancer diagnosis and intent of therapy (curative v palliative), and dose-limit warnings. We studied all prescriptions for 18 oral chemotherapies generated by oncology clinicians during the first 17 months after the safe prescribing enhancements were introduced, from May 1, 2010, to October 1, 2011. We examined the frequency with which clinicians used the new features, the number and type of alerts generated, and clinician actions in response to alerts.
Six hundred clinicians generated 6,673 prescriptions for 2,043 patients. Six drugs—temozolomide, capecitabine, lenalidomide, hydroxyurea, imatinib, and erlotinib—accounted for 5,512 of all oral chemotherapy prescriptions (83%). Prescribers indicated the intent of therapy 13% of the time and listed the patient's cancer diagnosis 46% of the time. Prescribers customized their instructions using a free-text field in 64% of prescriptions. Clinicians' 6,673 prescription attempts triggered 395 dose-limit warnings (5%), mostly for temozolomide. Clinicians ignored most (96%) warnings, because current dosing recommendations exceeded the dose-limit warnings for the alerted medications.
Oncology clinicians readily accepted features designed to enhance oral chemotherapy safety. Additional enhancements are needed to facilitate prescriptions with complex dosing regimens and to provide dose-limit warnings that reflect current clinical practice.
The principle aim of Ayurvedic aphrodisiac therapy Vrishya chikitsa is the birth of mentally and physically healthy children as they are the corner stones of a healthy future society. Modern life style is full of stress and competition thus interferes with physical mechanism of body creating psychosomatic impact leading to sexual inefficiency. Ayurvedic aphrodisiacs that enhance the vitality and give sexual power to couples, which enable them to give birth to healthy children. Western medicine relies on aggressive prescription of drugs and surgery to deal with many problems related to sexual dysfunction which in turn have unwanted and even dangerous side effects. In regards to this Scientists are searching for a safe and effective phytomedicine from Ayurveda.
Review of classical text and research data reported in various journals and monographs.
Vrishya chikitsa described in Ashtang Ayurveda mentions the reasons for sexual inefficiency and directs the use of several aphrodisiac herbs and minerals to enhance the vitality. Charaka has prescribed the use of aphrodisiacs that enhance the potency of a person. Ex. Ashwagandha, Mushali, Shatavari, Kapikacchu etc. Researches prove that, they enhance the reproductive capabilities and vigor of men while strengthening the body and overall well-being. In Ashwagandha main contain is withanolides, which are steroid lactones and have a quick and pronounced hormonal effect, which stimulate the development of testicular cells. Kapikacchu has been shown to increase sperm count. L dopa, a precursor of the neurotransmitter dopamine, isolated from Kapikacchu, has been shown to increase sperm production. The Vrishya chikitsa resorts to herb preparations and minerals, including nonpharmacological measures mentioned by Charaka like Sadvrutta palana and Aacharrasayana, also attain to enhance reproductive capabilities and vigor of men.
The herbs mentioned above and Sadavrutta, Achararasayana stands as an answer to solve problem of sexual inefficiency and enhance the potency of a person.
An analysis of 2,213 prescriptions written by physicians in a busy, urban pediatric emergency room revealed that only 110 or 5 percent had no errors or omissions of specifications. The quality of the prescriptions was evaluated according to the standards of acceptable prescribing for the following specifications: quantity, dosage, time interval between doses or specific hours to be given, and specific instructions. The hospital pharmacists, also under pressure, generally failed to monitor the prescriptions adequately--either they did not rectify the physicians' errors or at times they made incorrect changes. To improve the quality of prescriptions issued under pressure in an emergency room, several courses of action are recommended: Pharmacology departments of medical schools should place more emphasis on teaching students the art of writing explicit, comprehensible prescriptions. The physician and pharmacist should work as a team in the interest of providing patients with accurate and detailed prescriptions; or both the physician and the pharmacist should delegate the composition of prescriptions to an automated computer system, thereby reducing human error in writing and monitoring prescriptions and allowing both professionals more time for direct contact with patients.
Prescription is a written order from physician to pharmacist which contains name of drug, its dose and its method of dispensing and advice over consuming it. The frequency of drug prescription errors is high. Prescribing error contributes significantly towards adverse drug events. The present study was undertaken to understand the current prescription writing practices and to detect the common errors in them at a tertiary health care centre situated in a rural area of Western Maharashtra, India.
A cross sectional study was conducted at a tertiary level hospital located at a rural area of Maharashtra state, India during October 2009-March 2010. 499 prescriptions coming to medical store during period of one month were considered for data analysis. Important information regarding the patient, doctor, drug and the general description of the prescription were obtained.
All the prescriptions were on the hospital pad. A significant number of the prescriptions (n=88, 17.6%) were written in illegible handwriting and not easily readable. The name, age and sex of the patient were mentioned is majority of the prescriptions. All the prescriptions (100%) failed to demonstrate the presence of address, height and weight of the patient. Only the brand name of the drugs was mentioned in all the prescriptions with none of them having the generic name. The strength, quantity and route of administration of the drug were found on 73.1%, 65.3% and 75.2% prescriptions.
There are widespread errors in prescription writing by the doctors. Educational intervention programs and use of computer can substantially contribute in the lowering of such errors. A short course on prescription writing before the medical student enters the clinical field and strict monitoring by the administrative authorities may also help alleviate the problem.
Prescription; error; tertiary care hospital
Purpose: Physical therapists have engaged in cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) for decades, but the extent of their current involvement in this practice area is unclear. This study surveyed directors of CR and PR programs on a statewide level to ascertain what type of provider is writing the prescription, which methods of exercise formulation are used, which outcome measures are used and their congruency with established guidelines. Methods: A convenience sample of outpatient CR and PR directors (n=31) representing 38 CR and/or PR programs located in New York completed a survey in spring 2005 (29 CR and 9 PR). Results: Results showed that only 2 physical therapists were responsible for writing exercise prescriptions in CR and PR programs. Most program directors were registered nurses (53%), who also wrote the majority of CR exercise prescriptions. Exercise intensity was most frequently determined using formulae and data that were highly patient-specific. Clinical outcomes most frequently included Quality of Life scales and stress tests. Conclusions: Physical therapists are minimally involved in directing programs and writing exercise prescriptions. Exercise prescriptions are individualized to the patient. Outcome measures most frequently used by participating CR and PR program directors are consistent with nationally-recognized best practice.
cardiopulmonary rehabilitation program(s); exercise prescription; outcomes; training
Relatively little is known about the incidence of prescribing errors and there has been no work on this in a single specialty ophthalmic hospital. Knowing where and when errors are most likely to occur is generally felt to be the first step in trying to prevent these errors. This study is an attempt in, the setting of an eye hospital, to try to identify and attribute these medication errors.
The study setting was a single specialty eye hospital geographically separated from the main general hospital. Pharmacists prospectively recorded the number of errors of prescribing during a 4 week period at an eye hospital in UK. The errors were categorised as error of prescription writing or drug error. Potential significance of the errors was not addressed.
Overall 144/1952 (8%)prescription sheets had errors. 7% of the total errors were errors of prescription writing while 1% were drug errors. The majority of errors were made by junior doctors and no drug errors were made by senior doctors. The outpatients department had by far the highest prevalence of errors.
Certain areas within the hospital and certain grades of staff are more prone to drug errors. Further study is required to look at the reasons why this is so and what systems can be put in place to reduce these errors.
All prescriptions dispensed by one pharmacist during one month were examined for errors. Only 5·1 per cent of 2,237 prescription forms contained an error which meant the pharmacist had to contact the doctor. Thirty-seven per cent of prescriptions were either wholly or partly written by the receptionist. There was considerable variation between doctors and this varied from zero to 64 per cent; 4·0 per cent of prescriptions written by the doctor contained errors while those written by the receptionist were almost twice as likely (seven per cent) to do so. The majority of mistakes were obvious and trivial but five were potentially serious.
It is recommended that if doctors expect their receptionists to write prescriptions they should ensure that they are adequately trained to do so. The pharmacist can be a valued and trusted colleague who serves to protect patients from doctors' errors.