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Nurses correct doctors' prescribing mistakes but "pester" juniors

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Nurses provide a vital “safety net” by correcting junior doctors’ prescribing errors, research has found.

But junior doctors also blame nurses for “pestering” them into making hasty clinical decisions, the General Medical Council report has revealed.

The study – the first to report on the comparative safety of non-medical prescribers - found nurses made roughly the same amount of prescribing errors as consultant doctors and pharmacists.

Doctors relied “heavily” on nurses and pharmacists to identify and correct errors, particularly in their first year of training and when they were on-call and during ward rounds.

The report stated:” Nurses and pharmacists were the most important part of the safety net, although senior doctors were also discussed.

Nursing staff were regarded as experienced and able to point out errors to the prescriber concerned.”

But it added: “Foundation year one trainees also felt under pressure…when nurses were pestering them to write prescriptions.”

One junior doctor told researchers: “When you’re in a hurry people just tend to push scripts under your nose and say…’You need to get that signed, you need to prescribe that’”.

A “major cause of mistakes” was that junior doctors often assumed nurses would correct them or provide information without prompting.

Matt Griffiths, University of the West of England professor of prescribing and medicines management, said nurses needed to be more prepared to challenge doctors.

He said: “Nurses play a pivotal role as the last practitioner before that medicine gets administered.

“We’re a very hierarchical organisation and always assume that the next person above us knows better and we don’t question enough.”

The research involved 19 hospital trusts in North West England. It found that errors, occurring in around one in 10 hospital medication orders, were sometimes caused by “a lack of a safety culture”.

The findings have been published in the week the government has announced it will move “imminently” to amend the Misuse of Drugs Act to allow nurses and pharmacists to prescribe controlled drugs.

A nursingtimes.net snap poll found 88 per cent of respondents had stepped in to correct a doctor’s mistake.

Many commented on the need to incorporate prescribing into junior doctors’ core training.

One said: “It’s not ethically or morally right to expect junior doctors to prescribe drugs that they don’t understand, and ‘learn’ on vulnerable patients.”

Another said prescribing errors were “the tip of the iceberg”, adding: “I have had a doctor calling out my name with some urgency, whilst trying to take bloods (to check if it was a vein and not an artery!)”

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Readers' comments (2)

  • I read the report and it shows that nurse prescribers also make prescribing errors (though not significantly different from consultants) but the worrying finding is that nurses' prescribing errors were the highest in severity, with around 5% of their errors being "potentially lethal". we have to be very careful not to pick on doctors' prescribing mistakes when they are minor. It is important also to be objective when reporting these findings and not only to highlight what nurses want to listen to!!!!!!

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  • Being able to prescribe drugs involves a great understanding and experience in pharmacology, physiology and pathology. Historically and academically, it is obvious to say that Nursing is not Medicine, although both interact continuously and constantly towards the same goal: patient care and safety.
    Taking time to analyze a prescription and challenge it is important not only for the patient’s safety but also for our professional standing and status. However, the possibility for Nurses to prescribe drugs (even according to drugs’ schedules and classifications) could be the way forward to enhance the value of our profession or the dangerous path towards litigations and bad reputation.
    No one is immune from mistakes.
    So many questions remain unanswered:
    Do we have enough experienced Nurses with that caliber to comprehend complexities surrounding the act of prescription in our hospitals, given our current workload? What sort of Nurses do we want for the next decades? Is it worth to trigger competition between health professionals? Are we creating a misconception or misperception in the patients’ head? Would a common course between medical and nursing students in pharmacology and physiology be sufficient to manage drugs’ prescription effectively and safely?

    Abel (RN, Australia)

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