Repeat prescribing

In 1996 the MDU published an analysis of claims against our GP members resulting from medication errors. Twenty-five per cent of settled claims were directly related to problems in prescribing, monitoring or administering medicines. In almost half of the cases the injury caused was permanent and in eighteen per cent the error resulted in death, stillbirth or a termination of pregnancy. The drugs most frequently involved in medication errors were steroids, antibiotics, contraceptives, anticoagulants and non-steroidal anti-inflammatory drugs.

The Claims Handling Unit receive notification of such claims, many of which result from some failure of a repeat prescribing system. Systems for providing repeat prescriptions may offer particular opportunities for error. Errors occur with:

  • telephone requests
  • the issuing of prescriptions by non-clinical staff without adequate checks by the signatory
  • failure to monitor long-term drug therapy

Medical histories

A man was prescribed steroid eye drops following attendance at an Ophthalmic Outpatient Clinic. Over the next six years he obtained multiple repeat prescriptions, without attendance, from his General Practitioners. He suffered bilateral cataracts as a result. Looking back it was not possible to explain how this prescription had been provided on request for so long or without review. The MDU negotiated a settlement on behalf of all the GP partners.

By contrast, an asthmatic patient instructed solicitors to investigate a claim that his osteoporosis resulted from negligent prescribing of prednisolone over 10 years. The MDU was advised that the notes indicated that prescribing had been appropriate and referrals made as indicated. By the standards of the time the treatment provided was reasonable and, after exchange of expert evidence, the claimant discontinued his claim.

Misunderstandings regarding drug names occur from time to time and telephone requests have been the source of a number of medication errors. On a number of occasions, a request for 'some more of my pills' has resulted, not in the desired supply of oral contraceptives, but some other long-term medication instead. Whilst it sometimes appears astonishing that a patient would not notice the error themselves, it is difficult to mount a successful defence when a prescription is issued for the wrong drug.

In most cases, and in every case where the issues are complex, the MDU obtains the advice of an independent expert in general practice as to whether there has been a breach of duty. A doctor's management will be judged according to the standard of a reasonable practitioner. The relevant events may go back many years and the doctor's practice will be compared with that which was standard at the time.

It is important to remember that, although the doctor who actually signs the prescription will be held to be responsible for it, it may prove impossible to identify him/her many months or years after the event. This, and the involvement of non-clinical practice employees, means that such claims must frequently be dealt with on behalf of all the partners, whether or not they were directly involved in the events. The MDU will work closely with other medical defence organisations to minimise the inconvenience to our members throughout the investigation and resolution of a claim.

Reference

  1. Green S., Goodwin H. and Moss J. Problems in general practice - medication errors. The MDU, London 1996.

This page was correct at publication on 14/01/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.