Who makes prescribing decisions in hospital inpatients? An observational study

PURPOSE OF THE STUDY: Errors involving drug prescriptions are a key target for patient safety initiatives. Recent studies have focused on error rates across different grades of doctors in order to target interventions. However, many prescriptions are not instigated by the doctor who writes them. It is important to clarify how often this occurs in order to interpret these studies and create interventions. This study aimed to provisionally quantify and describe prescriptions where the identity of the decision maker and prescription writer differed. DESIGN OF THE STUDY: Observational data was collected in six wards, 2 weeks per ward, at a single large UK teaching hospital over a 12-week period from January to April 2011. RESULTS: In 112/183 (61%) cases where a new medicine was prescribed, the decision maker was not the prescription writer. CONCLUSIONS: Decision making and the writing of prescriptions are generally not undertaken by the same doctor. Moreover, communication about prescriptions is poor. Further research in a larger sample of hospitals is required to confirm generalisability of the results, and to inform educational interventions to reduce error rates.