Wednesday, 2 May 2012

Prescriptions and patient safety – it’s all about teamwork

Another shock horror medical story has been widely covered in the UK press today. ‘GPs making too many errors when prescribing drugs in patients, the official regulator says’  Another headline is enough to make any patient choke on their tablets, ‘lethal errors in 2 million prescriptions’

A BBC presenter on a radio phone-in programme dubbed pharmacists as ‘heroic’ in picking up and correcting the majority of prescribing errors.

As they say in all the best courtroom dramas – ‘let us look at the facts m’lud’

Yes – the study, by the General medical Council, based on 1200 patients confirmed that there are a significant number of errors in prescriptions written by GPs. To be precise, the figure quoted was 1 in 20 prescription items showed an error. Many patients are prescribed multiple medications, so this translated to an error for 1 in 6 patients and naturally this is more likely to affect the elderly who tend to take a variety of regular medications.

Only 1 in 550 of these prescription errors had lethal potential. Yes, this is still a frightening statistic but if you consider that the majority of the 900 million (yes, 900 million in England alone) prescriptions are checked and dispensed by pharmacists, the number of dangerous errors slipping through the professional net will be relatively small.

And as for heroic? It’s a pharmacist’s job to spot mistakes on prescriptions. These errors can include over or under dosage, drug interactions, inadequate monitoring, unsuitable treatment and lack of clarity on usage. Regular readers will know that I qualified as a pharmacist in another lifetime and practiced in hospital, community and industry. It was an acceptable part of my role that I discussed prescription anomalies with the prescriber and was never really a big deal.  Pharmacy training is complex, comprehensive and lengthy. A year’s post graduate tutelage follows a four year degree with on-going registration and education. For GP’s (and hospital doctors) on the other hand, prescribing is a small, but key part of the consultation/treatment process

That is why pharmacists are such an essential link in the treatment pathway. Not to trip doctors up but to identify and rectify prescribing weaknesses, and to support fellow clinicians in ensuring that treatment for every patient is as appropriate and safe as possible.

I welcome the GMC’s initiative with this survey and agree with their statement that ‘it’s important that we do everything we can to avoid all errors’. In my opinion, reducing the number of ‘dispensing doctors’ and ensuring that the pharmacist continues to act as a permanent safety net has got to be the best way to do this.

Andrew Lansley (remember him? Secretary of State for Health) said that the government would be working with GPs to improve practices, continuing ‘the vast majority of prescriptions are checked by community pharmacists who spot and put right any errors..’

As the NHS reform implementation continues and GPs become embroiled in budgetary control and potentially become distracted with commissioning, I suggest that pharmacists stay on high alert as this error rate could increase.


Chairman Chegwin said...


And if GPs didn't continually over-prescribe (whether under pressure from patients or simply as the least line of resistance), there would be fewer errors and the NHS drugs bill would be at a more manageable and reasonable level.

Perhaps we should give them 60% of the NHS budget to....oh wait....

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