Medication errors are one of the most common and preventable causes of patient harm in healthcare. They can occur at any stage of the medication process, from prescribing to administration, and are associated with increased morbidity, mortality, and length of hospital stay.
Up to 50% of medication errors occur during prescribing, making this a key area for intervention. Preventing prescribing errors requires a multidisciplinary team (MDT) approach, alongside careful, structured prescribing practices. This article provides a practical overview to support safe prescribing on the ward and is the fourth article in our series on how a MDT approach can prevent harm and lead to best patient care.
Contents
Types of Prescribing Errors
Common prescribing errors include:
- Incorrect drug or dose
- Omission of a required medication
- Incorrect route or formulation
- Wrong frequency or timing
- Prescribing a drug despite a known allergy
- Failure to account for renal or liver function
- Drug interactions or contraindications
These errors are often multifactorial and occur in busy clinical environments.
Risk Factors for Prescribing Errors
Several factors increase the likelihood of errors:
- Polypharmacy (≥5 medications)
- Older age and frailty
- Multiple prescribers
- Incomplete or inaccurate patient records
- Interruptions and workload pressures
- Poor communication within the MDT
Errors are more common during admission and discharge, where medication changes frequently occur.
MDT Approach to Preventing Errors
Medical Team
Doctors are responsible for safe and accurate prescribing.
- Prescribe with clear, complete instructions
- Avoid abbreviations and ambiguous terminology
- Check allergies, interactions, and contraindications
- Consider renal function, liver function, age, and weight
- Document indication and duration of treatment
Pharmacy Team
Pharmacists play a critical role in identifying and preventing errors.
- Perform medication reconciliation on admission and discharge
- Review prescriptions for interactions and dosing errors
- Support optimisation of high-risk medications
- Provide advice and education to the MDT
Nursing Team
Nurses are key in identifying errors before administration.
- Check medications prior to administration
- Identify discrepancies or unclear prescriptions
- Minimise interruptions during drug rounds
- Escalate concerns promptly
Wider MDT
Safe prescribing depends on effective teamwork.
- Ensure accurate documentation and communication
- Clarify unclear or incomplete prescriptions
- Support a culture where staff feel able to question and escalate concerns
Practical Prescribing Principles
Write Clear and Complete Prescriptions
- Include drug name, dose, route, frequency, and indication
- Avoid terms like “as directed” or unclear abbreviations
- Specify duration and total quantity
Consider the Patient
- Check allergies and previous adverse reactions
- Adjust doses for renal and hepatic impairment
- Use weight-based dosing where appropriate
- Be cautious in older patients and those with frailty
Reduce Common Errors
- Use metric units and clear decimal points (e.g. 0.5 mg, not .5 mg)
- Avoid look-alike or sound-alike drug confusion
- Be cautious with high-risk medications (e.g. anticoagulants, insulin)
Medication Reconciliation
- Confirm an accurate list of medications on admission and discharge
- Include over-the-counter and regular medications
- Ensure changes are clearly documented and communicated
Minimise Interruptions
- Avoid distractions when prescribing
- Support “protected time” during prescribing and drug administration
- Recognise that interruptions are a major contributor to errors
Systems and Safety Strategies
- Use electronic prescribing systems where available
- Engage with clinical decision support tools
- Encourage error reporting and learning from near misses
- Participate in root cause analysis where errors occur
A systems-based approach helps identify underlying causes and prevents recurrence.
Communication and Patient Involvement
- Communicate clearly with pharmacists and nursing staff
- Educate patients about their medications
- Encourage patients to ask questions and highlight concerns
Open communication is essential for reducing errors and improving safety.
Key Principles
- Prescribing errors are common but preventable
- Most errors occur at the prescribing stage
- Safe prescribing requires a coordinated MDT approach
- Clear documentation and communication are essential
- Small improvements in prescribing practice can have a significant impact on patient safety
Further Reading
- NHS England Medication Safety Management as part of good practice guidelines
- Read our Mind the Bleep article for further information on Common Prescribing Errors and further tips on how to avoid them as a resident doctor
Written by Dr A Sidhu (CT2)
