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Prescribing errors ‘found in one in 20 patients’

Around one in 20 patients were given a prescription that should have been avoided because it could worsen their condition or interact with other medications, an audit of over 500 general practices has revealed.

The study also found more than one in 10 patients had missed out on proper monitoring of their medications.

GP leaders said the findings could support the introduction of pharmacist-led prescribing reviews to help busy practices cut the risk of potential prescribing or monitoring issues – particularly for elderly and frail patients on multiple medications.

The audit was carried out on 2013 data from the Clinical Practice Research Datalink (CPRD) for 526 practices, including almost five million patients, using a set of prescribing and monitoring safety indicators previously developed from work done on the PINCER study – a Government backed pilot which showed pharmacist reviews helped to reduce prescribing errors by 30%.

Overall, around 5% of patients at risk of a potential prescribing error – because of a condition or being on medication – triggered at least one prescribing safety alert, while almost 12% at risk from a repeat prescription had at least one monitoring alert.

The most common individual prescribing error was use of aspirin or clopidogrel without any gastroprotection in patients with a history of peptic ulcer, which occurred in 10% of those at risk.

Older patients and those on multiple repeat prescriptions were the most at risk, but there was also wide variation between practices.

The study authors said their study ‘emphasises existing prescribing risks and the need for appropriate consideration within primary care, particularly for older patients and those taking multiple drugs’.

And while they acknowledged that prescriptions may have been initiated in secondary care, they said the audit showed there is ‘potential for improvement through targeted practice level intervention’.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said it was becoming ‘all but impossible’ for GPs to spend time checking for medication errors, particularly with the increase in frail elderly patients under their care, and that he would welcome the introduction of pharmacists to review practices’ prescribing to help cut down on prescribing and monitoring errors.

Dr Green said: ‘Although all GPs are aware of the need to monitor the drugs we prescribe it is all but impossible to give the task the time it deserves.’

He added: ‘I am convinced that the incorporation of pharmacists within practices would be a significant benefit, improving prescribing for patients and also improving the general care GPs can give by freeing up time for the things only we can do.’

However, he said that this would be ‘be most effective if aimed at providing pharmacists within practices, rather than expanding the role of community pharmacy, which as we have seen has the potential to duplicate, fragment, and destabilize existing services’.

An NHS England spokesperson said: ’NHS England has recognised the importance of regular review and monitoring, and in particular the role that clinical pharmacists have to play in this process, which is why we are investing in a scheme to get pharmacists into GP surgeries to advise on these and other issues.’

BMJ 2015; available online 3 November


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