Helping reduce medication errors and improve patient wellbeing

Professor Bryony Dean Franklin’s research into medication errors and strategies to prevent them has led to changes in clinical practice, guidelines and policy, both locally and nationally.

Package of medicine in tablet and pills form, in various colors

28 April 2022

Mistakes in prescribing and dispensing medication to patients is a serious problem in hospitals worldwide. An estimated 237 million medication errors are estimated to occur each year in England alone, costing the NHS around £98 million and an estimated 1,700 lives. The World Health Organization (WHO) set the goal of halving medication errors that result in harm between 2017 and 2022.

Professor Bryony Dean Franklin’s (UCL School of Pharmacy) research into medication and prescribing errors was the first to investigate the problem from the perspective of the people doing the prescribing, and the first to use a theory of human error to map the causes of prescribing errors at an individual, team and organisational level.

Her investigations across several hospital sites also found that because there was no transparent feedback system for flagging errors to the person who wrote the prescription, it was difficult to improve the situation.

Giving more feedback to doctors

Professor Franklin's research then focused on the acceptability and effectiveness of various ways of improving oversight and accuracy in prescribing in hospitals, including different models of providing feedback to doctors about prescribing errors. Her research found that doctors were receptive to direct feedback on errors, but that it was often inconsistent and too brief.

The team examined several measures including asking doctors to clearly write their name on prescriptions; increasing the feedback provided to prescribers about their prescribing errors; and providing generic advice about common and serious errors via a newsletter. This was found to result in an estimated 18% reduction in prescribing errors across seven hospital sites. Professor Franklin’s findings have been used in junior doctor training and incorporated into clinical prescribing guidelines in the UK, as well as being used as a model for training at the London North West University Healthcare Trust.

A question mark over smart pumps

Professor Franklin has also examined the role of technology and patient involvement in reducing medication errors. She and colleagues conducted the largest study of the safety of intravenous infusions to date, observing infusions across 16 NHS England hospitals.

Her research showed that ‘smart’ infusion pumps, which incorporate error-prevention software had no demonstrable benefit in practice, with similar error rates as conventional pumps. After presenting this finding to a 2019 UK parliamentary round table, the Health Safety Investigation Board incorporated her research into its investigation into patient safety and the use of ‘smart’ infusion pumps in the NHS.

The case for patient involvement

Professor Franklin also led research into how involving patients in administering their medication can improve safety, with patients and the public collecting and analysing the data alongside academics. This found very limited patient involvement in medication safety, despite widespread interest in patients being involved in administering their own medication, and that only 2% of patients across the two participating hospitals had been shown their inpatient medication records.

Professor Franklin helped design NHS patient information about self-administration of medicine in hospital, and her work was cited as evidence of good practice for making self-administration available in all NHS England organisations.

This pioneering work has had a significant impact on medical practice and training. Professor Franklin is the lead author on a 2020 update to the WHO Inter-Professional Medication Safety Curriculum Guide, due to be published shortly, used to guide undergraduate and professional training around the world.

Research synopsis

Improving patient wellbeing and reducing risk by transforming how medication is delivered

UCL’s Prof Bryony Dean Franklin’s research into errors in medication and her development of strategies to prevent them has led to changes in clinical practice, guidelines and policy, both locally and nationally. This has resulted in an estimated 18% reduction in errors in one study, changing recommendations around use of automated pumps to administer intravenous medication to hospital inpatients, and improving patient wellbeing and engagement by encouraging self-administration of medication. Her work has also informed medical educational practice and international health policy via the World Health Organization.

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