Study: GP prescribing errors – comment

pulse logoA recent widely reported study of prescribing errors by GPs has found 1 in 20 prescriptions contained errors. GP magazine Pulse and the BBC have highlighted the conclusions of a study carried out by the University of Nottingham published in May 2012.

Pulse reported:

The study examined nearly 1,800 patient records. There were 247 prescribing errors identified, the most common of which were ‘incomplete information on the prescription’ (31%), dose errors (17%) or timing errors (11%). There were also 55 monitoring errors, the most common of which was a ‘failure to request monitoring’, found in 70% of cases. Fewer than 4% of the errors were judged to be severe, although errors were more common in older patients and in patients receiving five or more drugs.

The study finds no one factor determines when errors are likely to occur. Factors associated with increased risk of prescribing or monitoring errors include: male gender, age less than 15 years or greater than 64 years, number of unique medication items prescribed, and being prescribed preparations in the following therapeutic areas: cardiovascular, infections, malignant disease and immunosuppression, musculoskeletal, eye, ENT and skin. Prescribing or monitoring errors were not associated with the grade of GP or whether prescriptions were issued as acute or repeat items.

The report concluded:

Prescribing errors in general practices are common, although severe errors are unusual. Many factors increase the risk of error. Strategies for reducing the prevalence of error should focus on GP training, continuing professional development for GPs, clinical governance, effective use of clinical computer systems, and improving safety systems within general practices and at the interface with secondary care.

GPs routinely use computerised prescribing systems which highlight nearly all potential interactions between medications. There are usually a large number of warnings for patients taking multiple medications. Many drug interactions are likely not to be of clinical significance. GPs can get into the habit of ignoring computerised warnings, most of which are unimportant.

Dr Fox uses a combination of a computerised system, and patient self-checking for interactions, during online consultations leading to private prescriptions. GMC registered doctors review consultation answers and our pharmacists also perform their own checks as required. Only a limited range of medications are prescribed, for which patient information pages are provided to help to assure safe prescribing. Patients are required to read patient information leaflets supplied with their medication.

A combined approach, which enlists the participation of patients, has resulted in a robust prescribing process, which to-date has a good safety record. In my view, in some cases, patients themselves could be encouraged to participate in the prescribing process to a greater degree than is usual within general practice.

A further article from the BBC, ‘Errors with prescription drugs: Your views’, highlights the consequences of some significant prescribing errors.

Dr Tony Steele (Medical Director Dr Fox online clinic)

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