Rocket scientists need not apply

Editor – We wholeheartedly agree with your recent editorial.¹ Like the hospitals studied by Barton et al² we fortunately have few serious medication incidents (mainly due to pharmacy intervention), but a good deal of ‘low level crime’ in terms of legibility and allergy documentation, in addition to other areas. The causes are varied. Clinician training in practical pharmacology (one to two years part time versus five years) is minimal compared to hospital pharmacists and drug knowledge is limited. A recent survey of our trainee doctors showed that 8/44 did not realise Tazocin was a penicillin and 7/44 thought meropenem was. Similar problems have arisen with Timentin. To compound the issue, only 10/44 trainees said that their consultants checked the drug chart on a ward round ‘nearly all the time’ or ‘all the time’. Unfortunately, our nursing colleagues are often the healthcare professionals disciplined for prescribing errors.

We have used regular updates on our intranet, mandatory briefings, individual and consultant reflection, free hospital name stamps and laminated lanyard ‘credit card’ aide memoires, all with limited success. Benefits from a post-take ward round checklist have been demonstrated elsewhere.³

A national drug chart (as in Wales)⁴ would be useful. Electronic prescribing may not be the cure-all that is hoped for and it will need the same national evidence-based approach. In addition, medical students need to get first-hand experience of hospital pharmacy, prescribing practice and nurse dispensing. Review of the drug chart should be standard ward round practice and organisations should have standard feedback mechanisms for prescribing errors.