Long-Term Prescribing Tops List Of Medication Error Claims Reveals MDU, UK

Main Category: Primary Care / General Practice
Also Included In: Litigation / Medical Malpractice
Article Date: 13 May 2009 - 4:00 PDT

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The MDU, the UK's leading medical defence organisation has warned its GP members of the risks when dealing with patients requiring long-term medication. The MDU, which represents over half of UK GPs, revealed that this type of prescription featured most commonly in a review of settled medication error claims against GP members.

While the vast majority of the millions of drugs prescribed in the community are prescribed appropriately, medication errors are still one of the main reasons for settling claims on behalf of the MDU's GP members. In this study of 69 settled medication error claims over a recent two-year period*, the MDU's clinical risk manager, Dr Karen Roberts found that just under one-third (21) concerned problems with administering repeat prescriptions of medication such as hypnotics, benzodiazepines and steroids. Problems reported ranged from the side-effects of long-term use, to patients who eventually became addicted to a particular drug.

Dr Roberts explained: "With long-term medication, it's essential to keep lines of communication between doctors and patients open. For example, GP practices should have a system in place to review patients with chronic conditions to check they are taking the drug correctly and not experiencing any adverse reactions. Regular reviews provide an opportunity to carry out an appropriate examination and tests and talk to the patient about their health and medication."

"In general, breakdowns in communication are a feature in many medication error claims. For this reason it's important that doctors ensure that patients understand what they are taking, the risks involved, any side-effects and possible harmful interactions with freely available drugs or remedies such as between alcohol and certain antidepressants or between St John's Wort and the contraceptive pill."

The reasons for the settled medication error claims were as follows:

- Problems with long-term medication - 21
- Wrong/ inappropriate drug - 17
- Dose error - 14
- Failure to prescribe - 4
- Administration error - 3
- Prescribing to a patient with a known allergy - 2
- Other - 8

The damages and costs awarded to the claimants ranged from over £1million for multiple drug prescribing resulting in cardiac arrest and brain damage, to £500 following the prescription of the heart medication, hydralazine, instead of the antihistamine, hydroxyzine to a child with a chronic skin disorder.

Dr Roberts' article includes common sense risk management advice for GPs to help them avoid the common prescribing pitfalls highlighted by the analysis:

- If prescribing drugs you are unfamiliar with, check contra-indications and side-effects

- Check the patient's past medical history and concurrent medication before prescribing any new drug

- Take special precautions when prescribing medications with a similar name

- Provide patients with information about their medication, in written form if necessary, including when to return for review

- Records should include who initiated the treatment, who signed the repeat prescription and how many prescriptions can be issued before a review

- Where care is shared between primary and secondary care, the letter provided to the GP should include all necessary information about the patient, the condition, the dose regime, frequency and formulation of drug and who will be responsible for follow up and monitoring.

- Be aware of relevant guidance, including the GMC's Good Practice in Prescribing Medicine (2008), the BNF and BNF for Children and alerts from the NPSA

- If an adverse event occurs, the patient should receive an explanation and an apology, if appropriate, after they have received appropriate treatment.

The article includes examples of medication errors notified to the MDU, including that of a woman who made a claim against her practice, alleging that her doctor had failed to warn her of the possible side-effects of her medication and failed to monitor her after repeat prescribing of steroid creams for her psoriasis led to skin striae and thinning of the skin.

Source
Medical Defence Union

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