Prescribing continues to be one of the top five risks in general practice based on Clinical Risk Self Assessments (CRSAs) conducted by the Medical Protection Society (MPS) at more than 150 practices across the UK and Ireland in 2013.
Data from assessments conducted in 2013 revealed that 95.4% of practices visited had risks relating to the prescribing system. Common specific examples include uncollected scripts, repeat prescribing systems, and administrative staff changing medications on the computer.
Uncollected scripts accounted for 53% of prescribing risks
Ms Julie Price, Clinical Risk Manager at MPS, said:
"We found that a number of practices did not have a robust system in place to alert the prescribing doctor to uncollected prescriptions. Clinicians should be able to review uncollected scripts to check whether any further actions is needed as a consequence of non-compliance, this is particularly important when dealing with vulnerable patients."
MPS advises practices to consider making a note on patients' records when they have not collected their prescription. This would alert the doctor to possible non-compliance and highlight to patients that a control mechanism is in place.
Repeat prescribing protocols accounted for 50% of prescribing risks
On poor prescribing protocols, Ms Price said:
"Some of the practices we visited did not have a written repeat prescribing protocol, or if they did, it contained insufficient detail of the process. The CQC will be looking to see whether a practice has suitable arrangements to ensure that patients have their medicines when they need them, and in a safe way. It is important that practices draw up a comprehensive and robust repeat prescribing protocol that formalises prescribing systems, ensuring that all staff are trained in the procedure and have access to the protocol."
MPS noted in a small number of practices doctors ask administrative staff to make changes to the repeat prescription screen after hospital discharges. This is risky practice which can lead to errors.
Advising on best practice, Miss Price said:
"To avoid errors, ideally the responsible doctor should add the medication to the prescription list. If administrative staff need to change or add medications, it must be closely checked by the doctor afterwards. Considerable care needs to be taken to ensure that all the details are correct and that it has been added to the correct patient record. Ultimately the doctor has responsibility for the prescriptions they sign."
The data was collected by MPS analysing the results of 153 (CRSAs) of general practices conducted in 2013. The top ten risk categories are as follows:
|Risk||Percentage of practices who identified the risk|
|3. Health & Safety||97.4%|
|5. Record Keeping||89.5%|
|6. Infection Control||88.9%|
|7. Staff training||88.9%|
|8. Test Results||88.2%|
|9. Appointment and Access||81.7%|
|Prescribing risk issues||Percentage of practices who identified the risk|
|Repeat prescribing policy||48.7%|
|Administration staff changing medications on computer||26.8%|