Abstract

Introduction: There are well-established benefits from reporting medication errors and identifying patterns to help prevent future harm. In the UK, prescribing errors originating from general practice and other community services are often identified and rectified within community pharmacy. Organisational structures within NHS primary care mean that boundaries between these independent organisations may act as barriers to error reporting and associated learning.

Aim: To identify key facilitators and barriers to cross-organisational prescribing error reporting and learning across primary care and to explore the role of community pharmacy within this.

Methods: Qualitative semi-structured face-to-face and telephone interviews were conducted with a purposive sample of pharmacists, prescribers and other key stakeholders from 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 role of community pharmacy in optimising prescribing error reporting and learning. Data collection and analysis were underpinned by the Theoretical Domains Framework [1]. Framework analysis [2] was used for coding and charting the data with the assistance of NVivo software (v12).

Results: Interviews included a range of perspectives from primary care prescribers (n=11), pharmacists (n=12) and other key stakeholders (n=12). Findings highlight how decision-making processes, practices and beliefs around prescribing error reporting differ significantly across and within different primary care settings, resulting in reporting variability and potential gaps in knowledge. Emergent themes were mapped to the TDF. Social influences, environmental context and resources (e.g. organisational cultures, local leadership and relationships, heterogeneous regulatory and reporting processes and systems, and beliefs about ownership, accountability and responsibility) were found to play a key role in the opportunities and motivation to report prescribing errors. For example, within general practice, approaches to risk management were mainly described within “significant event” and quality improvement paradigms. In community pharmacy, the focus was on checking and rectifying errors (rather than reporting) along with a clear distinction between the reporting processes associated with dispensing and prescribing errors. Beliefs about consequences of reporting also influenced reporting behaviour (e.g. stigma and blame; compliance with regulatory and contractual frameworks; medico-legal issues; impact on working relationships; and availability of feedback and learning potential). Constraints on the ability to report included: the ease of use of reporting systems; conflicting workload pressures; and varied individual interpretations of terminology, procedural knowledge, potential significance and wider learning potential associated with different types of prescribing errors.

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 was acknowledgment of a potential increased role for community pharmacy in the identification of wider prescribing error patterns. Findings suggest that feedback and learning need to have a local focus, be perceived to have positive and significant potential to change practice, and be tailored appropriately to each setting. Further research is required to help identify consensus on how best to facilitate cross-organisational knowledge sharing, learning and prescribing quality improvement.

References
1. Atkins L, Francis J, Islam R, et al. (2017) A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Science 12: 77.
2. Ritchie J and Spencer L. (1994) Qualitative data analysis for applied policy research. In: Bryman A and Burgess RG (Eds) Analyzing qualitative data. 173-194.