Prescribing

  • Prescription errors are one of the most common subjects for a claim notified to the MDU.
  • In an analysis of MDU closed cases between 2011 and 2015, 217 related to prescription errors.
  • Other areas of risk include long-term administration, dose error and allergy.
  • You are responsible for all prescriptions you sign.

Your prescribing duties

You have a duty to understand the drug you are prescribing, including any adverse side effects, contraindications and appropriate monitoring.

You are responsible for the prescriptions you sign, even if they have been produced by non-clinical staff. You should be sure that the drug and dosage are correct.

Before prescribing

You should familiarise yourself with current national guidance, including:

Check the patient's medical history and current medication, including OTC drugs they take regularly, such as NSAIDs.

When prescribing drugs you are not familiar with, check contraindications and side effects, and seek advice if necessary. Also, check the automatic drug interaction warnings on computerised prescribing systems before deciding it is safe to override them.

Ensure you have selected the right drug, preparation and strength when picking from the drop-down list.

Types and causes of error

Errors leading to a complaint or claim may arise, for example, if:

  • a busy doctor inadvertently clicks on a similar-sounding drug on the drop-down menu
  • a telephone message is misinterpreted
  • the prescription is issued by non-clinical staff
  • failure to monitor long-term drug administration leads to harmful side effects.

In an analysis of MDU closed cases between 2011 and 2015, 217 related to prescription errors. The most common drug-related errors were:

  • prescribing a drug to a patient with a known allergy, in particular penicillins
  • prescribing the wrong drug, due to them having similar names, eg mefloquine and malarone
  • prescribing the wrong dose of a drug, eg a twice-weekly drug being prescribed daily.

Avoiding errors

Satisfy yourself that the drug you are prescribing is the best option for the patient.

The GMC expects you to talk to the patient about their medication, explaining:

  • the risks and benefits of treatment, including possible side effects
  • what to do if they experience side effects or recurrence of their condition
  • how and when to take the medicine, and how to adjust the dose if necessary
  • the likely duration of treatment
  • arrangements for monitoring, follow-up and review.

GP practices are advised to have a system in place for reviewing patients on long-term medication, and to frequently review patients taking high-risk drugs such as lithium.

When care is shared between primary and secondary care, it is advisable to have a protocol in place setting out who is responsible for prescribing, monitoring and follow-up.

If a patient experiences an adverse reaction to the drug prescribed, you must explain what you think has happened, what you are going to do to help them and apologise if there has been an error. Record all adverse reactions in the patient’s records and report them through the MHRA yellow card scheme.

Finally, ensure you and your practice learn from medication errors through significant event audit, to minimise the risk of a repeat incident. Where patient safety has been or could have been compromised, you should report the incident to the National Reporting and Learning Service (NRLS).

Remote prescribing

Remote prescribing is only appropriate for some drugs and treatments, and for some patients. The GMC stresses that doctors must consider the limitations of electronic communication (phone, internet, Skype etc) when consulting remotely.

You should only prescribe remotely when:

  • you are satisfied that you are in a position to prescribe safely
  • you are prepared to ask the patient to come in for a physical examination
  • you have adequate knowledge of the patient’s health
  • you are satisfied that the medication you prescribe serves the patient’s needs.

Patients should also be made aware of the limitations of a remote consultation and have given their consent to continue.

Injectable cosmetic treatments must not be prescribed remotely.

Remote prescribing for patients overseas may be in breach of ethical and legal obligations if you are only registered to provide medical care in the UK.

A remote consultation, whether by phone, email or web, forms part of the patient’s record and should be stored securely.

This guidance was correct at publication 05/01/2018. It 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.

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