Exploring the impact of pharmacist-led feedback on prescribing behaviour: A qualitative study.

Background: Prescribing errors occur frequently in hospital settings. Interventions to influence prescribing behaviour are needed with feedback one potential intervention to improve prescribing practice. Doctors have reported a lack of feedback on their prescribing previously whilst the literature exploring the impact of feedback on prescribing behaviour is limited.

Objectives: To explore the impact of pharmacist-led feedback on prescribing behaviour.

Methods: Semi-structured interviews were conducted with doctors who had received prescribing error feedback. A topic guide was used to explore the type of error and what impact feedback was having on prescribing behaviour. All interviews were transcribed verbatim and analysed thematically using a framework approach.

Results: Twenty-three prescribers were interviewed and 65 errors discussed over 38 interviews. Key themes included; affective behaviour, learning outcome, prescribing behaviour and likelihood of error recurrence. Feedback was educational whilst a range of adaptive prescribing behaviours were also reported. Prescribers were more mindful and engaged with the prescribing process whilst feedback facilitated reflection, increased self-awareness and informed self-regulation. Greater information and feedback-seeking behaviours were reported whilst prescribers also reported greater situational awareness, and that they were making fewer prescribing errors following feedback.

Conclusions: Pharmacist-led feedback was perceived to positively influence prescribing behaviour. Reported changes in prescriber behaviour resonate with the non-technical skills (NTS) of prescribing with prescribers adapting their prescribing behaviour depending on the environment and prescribing conditions. A model of prescribing is proposed with NTS activated in response to error provoking conditions. These findings have implications for prescribing education to make it a more contextualised educational process.