An investigation into prescribing errors made by independent pharmacist prescribers and medical prescribers at a large acute NHS hospital trust: a cross-sectional study

Introduction: Pharmacists in the UK can register as independent pharmacist prescribers (IPPs) on completion of appropriate higher education training. IPPs have had the same prescribing privileges as medical doctors since 2009. Despite the years since their introduction, there are little data available to demonstrate the frequency and type of errors made by IPPs. Furthermore, there is no literature available comparing IPPs to doctors with regards to prescribing safety. This study aimed to start to fill this gap in the literature.

Methods: Pharmacists working in one National Health Service (NHS) Trust, in areas with a large proportion of prescribing undertaken by IPPs, were purposefully recruited to collect data over a 1-week period in May 2018. They collected data on all prescription items validated that were prescribed by IPPs and doctors. Errors that were identified were recorded in detail. Data collection forms and error definitions were taken from the EQUIP Study, a large study looking at prescribing errors by junior doctors in the hospital setting.

Results: 5840 prescriptions items were recorded; 1026 (17.6%) were prescribed by an IPP. 479 errors were recorded in total. Experienced IPPs, had a 1% error rate (seven errors); IPPs with less experience had a 0% error rate. Overall the error rate for pharmacists was 0.7% (95% CI 0.0% to 1.0%). In comparison, doctors made an average of 9.8% errors (95% CI 9.0% to 11.0%). Pharmacists made significantly less prescribing errors than doctors (p<0.01). 85.7% of IPP errors were recorded as minor in significance, compared with an average of 31.7% for all doctor’s prescribing errors. Actual patient harm occurred from 0.04% of all prescriptions.

Conclusion: In a single NHS Trust, pharmacists make significantly less prescribing errors than doctors. Embedding IPPs with more integrated roles in the multidisciplinary team is recommended. Further large trials are required to validate the results of this study.