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The waiting game

DH to launch crackdown on prescribing errors

GP prescribing could come under scrutiny as part of a Government drive to cut medication errors.

The Department of Health said the scheme was likely to be launched early next year, at the latest, and that it was currently enlisting experts to set out its remit.

Primary care minister Steve Brine MP told delegates at the Royal Pharmaceutical Society Conference yesterday that health secretary Jeremy Hunt was working closely with NHS England chief pharmaceutical officer Keith Ridge on tackling prescribing errors.

This work is likely to focus on:

  • Improving communication and preventing errors when patients move between care settings;
  • How pharmacists can support GPs and care homes; 
  • The impact and uses of e-prescribing; and
  • Errors in seven-day services.

It also said there would be a public-facing programme focused on patients’ understanding of medicines, and a piece of work looking at any problems that may arise in the pathway from prescribing to dispensing and monitoring.

Mr Brine said: 'Studies currently indicate that up to 8% of prescriptions have a mistake in dosage level, course length or medication type –a risk which the WHO identifies as “a leading cause of injury and avoidable harm in health care systems across the world".

'Patient education and safe management of information will be at the heart of our efforts to tackle this serious issue. For example, we will need to improve how we use electronic prescribing, as well as how we transfer information about medicines between care settings, where there is significant scope for errors.

'Fundamental to this process is clinical leadership – and that begins with fostering the debate, inside and outside government – around how we can make these essential improvements to our healthcare system.'

A 2012 GMC analysis of prescription items found roughly one in eight patients was affected by a prescribing or monitoring error and, although only one in 550 errors was found to be severe, prompted changes to GP training.

A more recent audit of 500 practices’ prescribing, published in the BMJ in 2015, found around one in 20 patients received a prescription that should have been avoided as it could worsen their condition or interact with another medication.

GP leaders said at the time that pharmacist-led medication reviews could help boost safety and take pressure off GPs.

Readers' comments (26)

  • Wasn't this the study that recorded a prescribing error if the dosing instructions weren't specific enough, ie contraceptive pill 'as directed' rather than 'take one by mouth every day for three weeks, then omit for seven days before starting again...' or lancets for BM tests 'as directed' rather than 'prick finger with sharp end, use a new needles for every test, dispose of safely...'
    Almost every script for prn medication or moisturiser fails this test. Flawed data

    Agree with Dr De'ath above. Most dodgy prescriptions I issue are for drugs recommended by single issue specialists at hospital, some of whom have no concern for anticholinergic load, glaucoma risk, renal function, or common sense, as long as they have recommended the latest untried flavour of the month therapy. Cardiologists seem to be the most reckless with huge statin doses, amiodarone, anticoagulants in the extremely frail to mention a few. Sad to say, single issue specialist nurses can also some of the worse offenders (heart failure, continence, IBD, parkinsons in particular), and its a difficult conversation with the patient to explain that the wonder drug they have been promised is not safe for them to take.

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  • I assume that all other prescribers (prescribing nurse practitioners, pharmacists etc) never make any prescribing errors! Not!! If GP workloads were not so overwhelming then likely fewer errors would be made or, as mentioned, then one wouldn't be pressured to prescribe a pill for every ill.

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  • I agree with Dr Azeem Majeed, but can only add that the time and workload pressure general practice is under will make matters worse, and Jeremy Hunt will blame us. I see a lot of dodgy prescribing coming out of secondary care. Still keen to minimize errors on my behalf.

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  • Why don't we refuse to prescribe secondary care initiated drug make them responsible for their prescribing and drug budget.Really annoying that our consultant colleagues don't get roasted for their prescribing like we do.When we take over their prescribing we sign the paper it becomes our fault and responsibility.

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  • its high time that this issue is addressed
    i have been advocating the integration of Pharmacists for a long time
    Medicines optimisation should be the top priority which will save atleast £150 million if not £300 million

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  • I've never really understood the transfer of prescribing from secondary to primary care. Anyone looking on would see it as an accident waiting to happen. If I am not certain of the exact regime I write for clarification. My biggest pet peeve is the "vitamin D low please prescribe according to local protocol".... not until you've discussed it with the patient yourself, and you can read the protocol and tell me the exact dose and duration

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