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Avoiding prescribing pitfalls

There are an estimated 250,000 hospital admissions a year thought to be the result of medication-related problems – Dr Mike Wyndham gives a quick update to aid good prescribing

There are an estimated 250,000 hospital admissions a year thought to be the result of medication-related problems – Dr Mike Wyndham gives a quick update to aid good prescribing

• Polypharmacy is an increasingly important issue, with the elderly most at risk induced by problems such as impaired renal function.

• Potential drug interactions should always be considered. In the surgery, computer software which ‘red flags' interactions is an essential safety-net. In the home, the doctor is much more vulnerable and should remember to consult their BNF.

• Certain drugs are more likely to interact, for example macrolides and amiodarone. Make a mental note of these.

•Topical drugs are not inert and may cause systemic problems. For example, timolol eye drops may cause wheezing in patients with asthma.

• Rashes around wounds such as venous ulcers may be caused by the dressings being used on them, such as contact dermatitis.

• Ensure you have a system of review for repeat prescribing. This is particularly important for drugs such as lithium. In the Vision system, this can be done via the ‘medication review'.

• Check that patients who receive medication from secondary care have been properly counselled where appropriate. For example, amiodarone may cause pulmonary fibrosis and the patient should be warned about the significance of developing a cough.

• Your PCT pharmacy adviser should provide you with a list drugs that may be initiated in hospital and later prescribed in the community, for example methotrexate. You should be given a shared-care protocol by the hospital and the patient should have a personal shared-care record card.

• Make sure your prescribing is evidence based. It is worthwhile checking databases such as Cochrane (www.cochranelibrary.com)

• Hospital doctors may ask you to prescribe drugs off licence. Be sure that there is good evidence to support this treatment as you will be liable for problems that may occur as a result of the patient taking the drug.

• When you are prescribing for children, don't forget to think about whether they are at school. A four-times daily medicine will be hard to fit into the day and schools may not be happy to give out medicines.

• Remind parents/carers to check medicine flavours with the pharmacist to help compliance with children.

• Read the Drug Safety Updates from the MHRA to help keep up to date with medicine safety advice (drugsafetyupdate@ mhra.gsi.gov.

Dr Mike Wyndham is a GP in Edgware, Middlesex

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