Prescribing errors - how much should we worry?
Yet another terrifying headline today tells us that almost 2 million prescriptions a year have potentially serious errors. Mistakes range from not advising clearly on the dose to be taken, to prescribing medicines for people who are allergic to them, or not doing blood tests that could prevent the risk of serious complications.
But do we need to panic? Putting this research into perspective, ‘mild’ or ‘moderate’ errors are unlikely to bring any harm to patients. There were no serious errors identified in over 99.8% of prescriptions studied – and there are 900 million prescriptions issued in the UK every year.
Of course, there is no room for complacency. The vast majority of prescriptions are now issued on computers, using systems which flag up possible medicine interactions and other precautions for the patient. GPs must be trained to spot which ones could lead to a potentially serious problem. They need to work more closely with pharmacists, who have in-depth training on managing medicines safely. Just this week, we have taken on a pharmacist to work with the practice to assess all our highest-risk patients for exactly this issue.
The most worrying finding is that the vast majority of the serious errors related to prescribing of the blood-thinning agent, warfarin. Using this medicine is fraught with problems – it interacts with a dizzying array of food and drink as well as a host of medicines. It needs very regular monitoring to avoid dangerous bleeding if too much is given. However, giving too little is equally dangerous, as it’s mostly given to people with the heart condition atrial fibrillation (AF). People who have AF are 5-7 times more likely to have a potentially fatal stroke than other people, and using warfarin cuts this risk dramatically. There is absolutely no excuse for GPs not monitoring their patients on warfarin regularly. But there is also no excuse for taking the ‘easy option’ and giving less effective medicines like aspirin when the patient really needs warfarin.
My advice to worried patients? Keep calm and carry on, but take control. It’s time to start taking a closer look at your medication and talking to your GP or pharmacist about it. Whenever you’re put on a new medicine, check with your doctor if you need regular tests (eg, blood tests) to monitor it. If you need a blood test every six months, put a reminder in your diary. If you’re on a medication which needs very frequent monitoring, such as warfarin or some medicines used for rheumatoid arthritis, make sure you ask at the outset exactly what precautions the practice takes to invite you back in as often as you need. Make sure you know who to contact if you’re in doubt (this may be the practice nurse or a different GP at your practice who is in charge of this service). If you’ve ever been diagnosed as being allergic to any kind of penicillin, you should never have any other kind of this drug for the rest of your life. Check your medical records flag this up and don’t be afraid to check with the doctor that they’re aware of your allergy when you get any new prescription for antibiotics.
Your doctor certainly won’t mind you asking questions – in fact, they’ll welcome it. As the latest developments on shared decision making, doctors do recognise that it’s your body, and they’d really like to work with you to keep it healthy.