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Fatigue causes GP script errors

By Brian Kelly

A Government report has flagged up fatigue and excessive workload as important causes of GP prescribing error.

The report also blames 'significant variations' in the standard of practice IT systems for causing mistakes in drug monitoring and medication review.

Illegible scripts, dosage calculation errors, confusion over drug names and lack of knowledge about patients were all highlighted as significant problems that need addressing if the Government is to meet its target to cut serious medication errors by 40 per cent.

The report, published last week by the Department of Health, pointed to a stark lack of evidence on the prevalence of prescribing mistakes in UK general practice ­ although one of the biggest studies on the issue, covering 550,000 prescriptions, found an error rate of just one in 10,000.

GPs are urged by the report to introduce protocols to pre- vent prescribing errors in several high-risk areas (see below).

Problems linked to repeat prescribing were singled out. The report says research indicates 66 per cent of repeat scripts show no evidence of GP authorisation and 72 per cent have not been reviewed in the previous 15 months. It states: 'About 1.8 million prescriptions are written by GPs in England every day. The standard of prescribing is generally high but patients are too frequently harmed through avoidable errors.'

Professor Saad Shakir, director of the Drug Safety Research Unit in Southampton and a part-time GP in south London, said GP workload was a significant factor.

'Prescribing errors are an enormous problem. Part of the problem is preventable through more training and awareness but a real issue is that prescribing errors will

only be preventable when GPs get a realistic workload.

'They have to process such a large number of prescriptions that errors will inevitably creep in,' he added.

High-risk areas for GP prescribing error

 · Absence of a repeat prescribing protocol in many practices, leaving practice managers and receptionists to initiate most repeat prescriptions

 · Poor history taking in patients with allergic conditions, leading to preventable anaphylactic reactions

 · Failure to adhere to national guidelines on warfarin monitoring ­ oral anticoagulants are in the top three classes of drugs responsible for fatal medication errors in primary care

 · Confusion over methotrexate dosing, leading to daily rather than weekly administration ­ causing 25 deaths and 26 cases of serious harm in England over 10 years Source: Department of Health

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