Abstract

Background: In the UK, prescribing errors originating from general practice and other community services are often identified and rectified within community pharmacy. Organisational structures withinNHS primary care mean that boundaries between these independentorganisations may act a barrier to supporting error reporting and potential learning.

Aim: This study aimed to identify key facilitators and barriers to facilitating cross-organisational reporting and learning across primary care and to explore the potential role of community pharmacy within this.

Methods: Qualitative semi-structured face to face and telephone interviews (n = 16) were conducted with a purposive sample of pharmacists, primary care prescribers, and other key stakeholdersfrom across North East England. Interviews explored: facilitators and barriers to prescribing error reporting in primary care; the influence of decision-making processes and healthcare context; and the potential of community pharmacy in optimising prescribing error reporting and learning. Data collection and analysis were underpinned by the Theoretical Domains Framework. Framework analysis was used for coding and charting the data with the assistance of NVivo software.

Results: Decision-making processes, practices, and beliefs around which prescribing errors are deemed to be “significant” in relation toreporting and associated learning were found to differ significantly across and within different primary care settings. It was acknowledged that primary care organisations hold different approaches to risk and risk management and that community pharmacy could play a larger role in the identification of wider prescribing error patterns. Within general practice, the focus on prescribing errors reporting and learningwas mainly described within “significant event” and quality improvement paradigms. In community pharmacy, there was a focus on “prescribing interventions” (i.e. checking prescriptions and rectifying errors with the prescriber) rather than reporting and a clear distinction between the usual reporting processes for dispensing and prescribing errors. This was due to regulatory processes and contractual frameworks as well as beliefs, often based on organisational boundaries, about who “owned” and was responsible for the error. Community prescribers that sit under the remit of secondary care followed standard trust procedures in relation to error reporting. Key barriers to prescribing error reporting and learning include organisation culture and beliefs relating to stigma and blame; concerns about the potential impact on working relationships; heterogeneous regulatory and reporting processes and responsibility for the identification of error patterns; lack of feedback from standard reporting systems; beliefs about the significance and learning potential associated with different error types; and a lack of time and resources.

Conclusion: There seems to be a lack of clarity and consistency across primary care in relation to beliefs about whose responsibility it is to report prescribing errors, which errors should be reported, how, when,and to where. There is acknowledged potential to facilitate learning and improve the quality of prescribing by sharing cross-organisational knowledge on prescribing errors and significant events, as well as patterns of inappropriate prescribing. Feedback and learning needs to have a local focus, be perceived to have positive and significant potential to change practice, and be tailored appropriately to each setting.