Prescribing errors with High Risk Medicines (HRMs) in Hospitals

  • Mahdi Alanazi

Student thesis: Phd


Background: Prescribing errors are the most frequent type of error in the medication use process. High risk medicines (HRMs) are a sub-class of medications that if used erroneously have potentially devastating consequences which defined by Institute for Safe Medication Practices (ISMP) as the drugs that bear a heightened risk of causing significant patient harm when they are used in error. Therefore, prescribing errors with HRMs are of concern to healthcare professionals that are responsible for ensuring mitigating patient safety. This thesis examines to what extent prescribing errors with HRMs in hospital occur, the causes of prescribing errors with HRMs and the differences to non-HRMs and the prescribing errors with HRMs during the on-call period. Method: The research adopted a mixed methods approach to explore prescribing errors with HRMs in hospitals and three studies were undertaken. The first study was a systematic review of the literature to explore the prevalence and incidence of prescribing errors with HRMs in hospitals. The second study was a secondary analysis of 59 existing interviews with foundation year doctors to explore the causes of prescribing errors with HRMs and compare them to those for non-HRMs reported in the same interviews. The third study was a qualitative study of the challenges of prescribing HRMs safely during the on-call period. This final study involved six focus groups with foundation year doctors (total participants number was 42). Results: Overall, findings demonstrated that there is paucity of studies that explored the prevalence of prescribing errors with HRMs and this literature showed inconsistency in definitions of prescribing errors, HRMs lists, severity scales and study methods (Study One). This resulted in a very wide range of prevalence of prescribing errors with HRMs. In terms of causes of prescribing errors with HRMs (Study Two), prescribing HRMs was considered a complex task for participants, especially those requiring dosage calculations, errors in the legal prescription requirements for controlled medications occurred with HRMs only and the on-call period was a particularly challenging period to prescribe safely especially with HRMs. In Study Three, the reasons found for this include the nature of the on-call period as a fast-paced environment, the methods of communication such as the bleep system, lack of accessibility to patient information and lack of plan from the primary team. Conclusions: HRMs form part of general medications, meaning they share similar traits, but the potentially devastating consequences of HRMs and the complicated task posed by prescribing them makes errors in their prescription profound. Therefore, HRMs need closer attention and more concern from healthcare professionals, researchers and policymakers. Such attention could result in a significant reduction in adverse outcomes and improved patient safety.
Date of Award31 Dec 2018
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorMary Tully (Supervisor) & Penny Lewis (Supervisor)


  • Foundation doctors
  • On-call
  • Systematic review
  • Junior doctors
  • Qualitative research
  • Inpatients
  • Hospitals
  • High alert medications
  • High risk medicines
  • Prescribing errors
  • Medication safety

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