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PCOs to audit GP notes to curb allergy errors

Primary care organisations will audit GPs' notes in a bid to cut the number of 'potentially devastating' prescribing errors in patients with allergies.

A major new Department of Health report has recommended that all notes should be flagged with patients' allergy status ­ irrespective of whether the patient has known allergies.

This should be done in such a way that it will trigger a prescribing error alert, the report written by the Chief Pharmaceutical Officer said.

Allergy status would then be referred to each time a patient was reviewed by a member of the practice team.

PCOs should also introduce written standards for documenting drug allergies, including the role and responsibilities of GPs, nurses and hospital doctors.

Audits will then be carried out to assess the standard of allergy documentation in practices and hospitals and the results fed back to GPs through clinical governance processes.

The report highlighted vaccines, antibiotics, aspirin and other non-steroidal anti-

inflammatories as having the highest potential to cause anaphylaxis in susceptible patients in primary care (see right).

Medical defence bodies said 6-11 per cent of negligence claims involved allergic drug reactions. In many cases, the allergy history of the patients had not been available at the time of prescribing.

The report said: 'Serious harm has occurred when patients have been prescribed drugs to which they have a pre-existing allergy. Prevention of such errors relies on patients and medicines information being available and acted on at the time of prescribing.

'This type of error could be prevented with electronic prescribing systems linked to the electronic national care record.'

Dr Stephanie Bown, head of medical services at the Medical Protection Society in London, said 11 of the 193 claims to the MPS involving GPs in one year were because of allergic drug reactions.

'In the majority of cases, the errors arise not as a result of a single individual but because of an environment where several things have gone wrong and where there are system failures,' she added.

Professor Saad Shakir, director of the Drug Safety Research Unit in Southampton and a part-time GP in south London, said auditing GPs was one way of tackling the problem but added: 'Auditing will be difficult considering GPs' intense workload.'

Drugs linked to

anaphylactic

reactions include:

 · Amoxicillin

 · Vaccines

 · Suxamethonium

 · Allergen extract

 · Trimethoprim

 · Atracurium

 · Ciprofloxacin

 · Intravenous iron

 · Intravenous vitamins

 · Lidocaine

 · Propofol

 · Thiopental

Source: CSM reports

GPs told to report 'near misses'

GPs are being urged by the Government to report 'near misses' or potential prescribing errors as well as mistakes that resulted in patient harm.

Reinforcing the message from the National Patient Safety Agency's anonymous 'no blame' system, the new Department of Health report said prescribing errors were under-reported because GPs feared litigation and disciplinary action or felt they were too busy to file a report.

It said low reporting rates denied the NHS the opportunity to learn from its mistakes.

'NHS boards should actively promote incident reporting within their organisations.

'The emphasis should be to identify risks and propose solutions to avoid future errors. While individuals involved must be accountable for their actions, they should not be

inappropriately blamed for

errors that occur,' it added.

The National Patient Safety Agency is setting up an

incident decision department to help managers decide the most appropriate course of

action following a serious

incident.

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