Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors
Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors
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DOI：
10.1186/1748-5908-7-86
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发表时间：
2012-09-11
影响因子：
7.2
通讯作者：
Bond, Christine
中科院分区：
文献类型：
--
作者：
Duncan, Eilidh M.;Francis, Jill J.;Bond, Christine
背景：处方错误是发病率和死亡率的主要来源，也是一个重要的患者安全问题。有证据表明，实习医生应为大多数开药错误负责。了解影响处方行为的因素可能会导致有效的干预措施，以减少错误。已有的关于处方差错的研究都是基于人的差错理论，而没有基于其他相关的行为理论。本研究的目的是运用理论领域框架(TDF)的广泛理论方法，调查实习医生在医院背景下的处方使用情况。方法：以12个理论领域为基础，对22名实习医生进行半结构式访谈，探讨他们在处方和处方错误方面的观点、意见和经验。结果：7个理论领域符合相关性标准：“社会职业角色和认同”、“环境背景和资源”、“社会影响”、“知识”、“技能”、“记忆、注意力和决策”和“行为规范”。通过对访谈数据的批判性评估，“对后果的信念”和“对能力的信念”也被确定为潜在的重要领域。域之间的相互关系很明显。结论：在本次基于医院的处方调查中，参与者对错误原因的归因被用来确定干预措施中可以针对哪些领域来改进处方。与以前的TDF做法不同的是，使用了批判性评估来确定也应作为目标的其他领域，尽管参与者认为这些领域与处方错误无关。这些是关于后果的信念和关于能力的信念。具体地说，鉴于有记录的高错误率，认为开错处方不太可能对患者产生后果，以及实习医生能够开出正确无误的处方的信念，也应该成为干预的目标。这项研究首次提出了对领域识别的批判性评估，并利用访谈数据提出了理论上的阐述和领域之间的相互关系。
Background: Prescribing errors are a major source of morbidity and mortality and represent a significant patient safety concern. Evidence suggests that trainee doctors are responsible for most prescribing errors. Understanding the factors that influence prescribing behavior may lead to effective interventions to reduce errors. Existing investigations of prescribing errors have been based on Human Error Theory but not on other relevant behavioral theories. The aim of this study was to apply a broad theory-based approach using the Theoretical Domains Framework (TDF) to investigate prescribing in the hospital context among a sample of trainee doctors.Method: Semistructured interviews, based on 12 theoretical domains, were conducted with 22 trainee doctors to explore views, opinions, and experiences of prescribing and prescribing errors. Content analysis was conducted, followed by applying relevance criteria and a novel stage of critical appraisal, to identify which theoretical domains could be targeted in interventions to improve prescribing.Results: Seven theoretical domains met the criteria of relevance: "social professional role and identity," "environmental context and resources," "social influences," "knowledge," "skills," "memory, attention, and decision making," and "behavioral regulation." From critical appraisal of the interview data, "beliefs about consequences" and "beliefs about capabilities" were also identified as potentially important domains. Interrelationships between domains were evident. Additionally, the data supported theoretical elaboration of the domain behavioral regulation.Conclusions: In this investigation of hospital-based prescribing, participants' attributions about causes of errors were used to identify domains that could be targeted in interventions to improve prescribing. In a departure from previous TDF practice, critical appraisal was used to identify additional domains that should also be targeted, despite participants' perceptions that they were not relevant to prescribing errors. These were beliefs about consequences and beliefs about capabilities. Specifically, in the light of the documented high error rate, beliefs that prescribing errors were not likely to have consequences for patients and that trainee doctors are capable of prescribing without error should also be targeted in an intervention. This study is the first to suggest critical appraisal for domain identification and to use interview data to propose theoretical elaborations and interrelationships between domains.