The scene

A patient in her 50s with COPD was admitted to the medical ward of the local hospital with a persistent cough and shortness of breath. She was diagnosed with an infective exacerbation of COPD and treated with oral antibiotics and steroids. The patient improved, finished her course of treatment and was awaiting discharge, when she sustained an accidental fall and injured her right shoulder.

She was seen by the on-call locum registrar, who made a thorough assessment and, following an X-ray, concluded that the injury was soft tissue only. The registrar advised conservative management and prescribed naproxen, with a seven-day supply being provided by the hospital pharmacy when the patient was discharged.

The locum post was only short-term and the registrar then moved away to be closer to family. Some time later, she received a request from the trust to write a statement relating to a pending complaint they had received from the patient, who had suffered a GI haemorrhage two months after discharge. She recovered, but a complaint was subsequently instigated relating to the initial prescribing of naproxen. Understandably concerned, the registrar called the MDU advice line.

MDU advice

The adviser explained that a request for information was a normal part of the trust's investigation into a complaint, and although the member's anxiety was understandable, the MDU could support her through the process and advise her about her response.

What became apparent from the extensive documentation was that the naproxen had continued to be prescribed after the patient was discharged from hospital. The registrar was concerned that she had not documented her initial risk analysis in deciding to prescribe the naproxen and not to co-prescribe a PPI, deeming the patient low risk.

With the support of the MDU, the registrar was able to write a comprehensive and robust statement that included not only what was documented in the notes, but also her recollection of events and her usual practice. She recalled thoroughly assessing the risks of adverse GI events with this patient and stated her usual practice, which was to supply only limited quantities with an emphasis on review before continuation.

The latter was corroborated by the discharge letter, which clearly stated a limited supply with subsequent review. The MDU adviser explained that it was acceptable to include these additional aspects in the statement as long as the registrar qualified which details were from memory or from her usual practice, and which had taken place.

The outcome

The registrar submitted her report to the trust and subsequently learned that the patient was content with the trust's response and didn't intend to pursue the complaint any further.

This dilemma is fictional but based on members' experiences and the types of calls we receive to our advice line.

Post-discharge prescription of naproxen

Related articles

Membership in your pocket