Erros de prescrição de medicamentos: causas e fatores subjacentes na perspectiva de médicos residentes

Abstract

In addition to patient harm, prescribing errors can lead to increased length of stay, care costs, and mortality rate. They are a reality of concern to both health professionals and patients, particularly in developing countries as the nature of drug damage in these countries differs from high-income countries in incidence and magnitude. Prescribing errors are made by any medical professional regardless of their experience and background, however, junior doctors are more likely to make prescribing errors compared to senior doctors, and although they cannot be responsible for all prescribing decisions in hospitals, junior doctors are usually responsible for most of them. Few studies have investigated underlying causes of these errors particularly, no Brazilian study has investigated in-depth the underlying causes of these errors from the junior doctors' perspective. Thus, the aim of this study was investigate medication prescription errors, their causes, and underlying factors from the perspective of junior doctors. The study used a qualitative approach, with data collection through individual interview and semi-structured script, with questions related to the planning and execution of the prescription. Interviews were conducted with 34 junior doctors. Data were organized with the help of Nvivo software and prescription errors were counted. The taxonomy of Otero-López et al. (2008) was used to name the types of reported errors and identified active prescribing failures for each error were classified according to Reason's model causes of accidents into execution errors (slips and lapses), planning errors (knowledge based mistake and rule based mistakes) and unsafe acts of violations. A total of 105 prescribing errors were reported. The most part of errors involved the omission of medication and the class of antimicrobial drugs. Applying Reason's model to data, most of these unsafe acts were errors of execution, followed by planning errors and violations. Slips due to attention failure, violations of rules and mistakes due to lack of knowledge were the most reported. Most of the errors that hit the patients were due to violations and slips. Work overload and time pressure were the most reported error-producing conditions. Deficiencies of the National Health System, and organizational difficulties in the local Hospital (inadequate prescription protocols and problems in the electronic system), among others, were identified as latent conditions. Our results reaffirm, following other studies, that the causes of errors are multifactorial. However, unlike other studies, many errors have struck patients and the data suggest these errors are related to the overuse and misuse of residents' work to fill health system gaps. This, combined with inadequate training, may have contributed furthermore for this picture. Considering that the difficulties of the health system can be one of the main causes of work overload, and that changes in this direction depend on broader national public policies, something more difficult to be improved in the short term, we suggest as an immediate action to discourage the culture of exploration of the Resident's work and prioritization of his training. Other local or multicenter studies, investigating cultural aspects that matter for understanding the causes of prescribing errors, in Brazil and other low- and middle-income countries, deserve to be conducted.