Positive prescribing

Errors in prescribing are a national problem. Julie Wilson, an experienced risk manager, gives her top ten tips for safe prescribing

You are Mrs Good’s GP. She has been a patient for many years. As her prescriber, you know what medications she is taking, including her repeat prescriptions and also her occasional acute medications. So there are no risks in prescribing to Mrs Good.

Or are there?

In reality, Mrs Good is cared for by a number of people – a locum, a GP registrar and a number of health professionals who work for the local out-of-hours provider, now that the practice has opted out of that service. Mrs Good has also visited the new surgery that opened at Sainsbury’s. They all prescribe to Mrs Good.

In addition there are the nurses – the practice nurse, a nurse prescriber who prescribes for Mrs Good when she attends the asthma clinic, and a district nurse who also prescribes when visiting her at home.

Mrs Good has a supportive family who collect her medication from the pharmacist. Her daughter, Gwen, occasionally gives her wellmeaning remedies that she has stored in her medicine cabinet. The pharmacist at Hoytown chemist prepares her medication and knows the products that Mrs Good buys over the counter, but no-one else does!

She also attends the local hospital where she has appointments to see:

• The cardiologist, following her heart attack last year.
• The ophthalmologist, for her glaucoma.
• The geriatrician, for that dizzy spell she had six months ago.

They all prescribe various medications to her. Last week, her medication was altered by a junior doctor who has since moved to Durham. Since then, she had a tooth abscess and visited her dentist who prescribed antibiotics. Mrs Good believes that by taking both complementary and conventional medicine, her recovery from recurring back pain will be accelerated. So she attends an alternative health practitioner who provides herbal remedies.

Back at the practice, the receptionist generates her repeat prescriptions and issues them when her relatives arrive to collect.

Alarm bells sound faintly in the distance – does Mrs Good’s GP have a record on his computer of everything that Mrs Good is taking?

A common problem

This is a typical picture of a patient; is there a “Mrs Good” in your practice?

Numerous people prescribed to Mrs Good so many risks have gone unaccounted for. It is imperative that these are identified to ensure that patients are not harmed.

Safe prescribing is not simply a matter of a GP printing out and signing a prescription; there are many steps involved in the prescribing process that involve all the practice staff.

Every year, 720 million prescriptions are issued in primary care, so it is no surprise that errors are common.¹ A study by Barber and Dean found that in one week in the North Thames region, pharmacists intercepted over 900 prescribing errors that they thought could have resulted in severe morbidity or death.²

Another study by Shah et al, carried out in the UK over a twomonth period, showed a prescribing error rate of 7.46% for over 37,000 items prescribed by 23 GPs.³

The MPS Risk Consulting team – which I am a part of – undertakes risk assessments of general practices. We analysed data between 2004 and 2006 to identify the most common risks in general practice. One of the highest sources of error was prescribing: 92% of the practices that we visited had risks associated with prescribing.
So what can we do to minimise the risk of prescribing? The answer is simple: read our Top ten tips for a safe prescribing process.