A new study exploring the origins of physicians' medication errors in England found that physicians, particularly younger ones, rely on both nurses and pharmacists to keep these mistakes from reaching patients. The December 2009 report was commissioned by the General Medical Council, the independent regulator of physicians in the United Kingdom. Researchers looked at 19 hospitals, finding more than 11,000 errors out of approximately 124,000 medication orders over a week's time. The reported overall cause of error was the absence of a "safety culture," including busy and stressful working conditions, violations of prescribing rules, and miscommunication. Specific errors included assuming that nurses would be aware of and point out information on conditions like patient allergies or other medications the patient was receiving.

This reliance on nurses as a safety net has been documented in the United States as well. A 1995 JAMA study showed that nurses were the practitioners most likely to intercept physicians' medication errors. Almost half of the errors discovered in the study were caught, and of those, nurses were responsible for finding 86%. Linda Flynn, associate professor at the University of Maryland School of Nursing in Baltimore, has studied what tasks nurses perform to catch these errors, identifying four primary ones: independently checking medication records, questioning the rationale for drugs, requesting that physicians rewrite illegible orders, and educating patients and families regarding medications. The likelihood of nurses performing these procedures hinged on how supportive the practice environment was and how frequently the nurses were interrupted while performing their job duties, she said. (See "An End to Interruptions: Nurses Preventing Medication Errors" at AJN Off the Charts: http://bit.ly/1NwC2l.)

Tammy Worth