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General Practitioners making too many mistakes in prescribing drugs study shows

By Paul Bisnar
Posted May 2, 2012 in Health
LONDON - According to General Medical Council (GMC) study released this May 2012, led by Professor Tony Avery of Nottingham University, General Practitioners (GPs) are making mistakes in drug prescriptions to one in eight patients.
The study called Prevalence and Causes of Prescribing Errors in General Practice (PRACtICe) involved examinations of prescriptions given to 1,777 patients. The aim of the study is to determine the prevalence and nature of prescribing errors in general practice, explore the causes, and identify solutions.
Study shows that elderly, over 75 years old, and children under the age of 14 are vulnerable to prescription errors.
Overwhelmingly majority of the prescription errors are not classed as serious, only 4% of errors showed as ‘severe’.
Errors identified
Example of minor errors are prescription of antibiotic twice during same consultation but with different doses stipulated to a one-year old girl, no instruction given to an adult patient how to apply or how often to use a topical steroid, and absence of instruction how often and how much dose of antibiotic prescribed to a 29 year old patient.
Moderate error practices include no concomitant medication was prescribed for gastric protection to an elderly patient who was prescribed Ibuprofen, a known stomach irritant, after a road accident. Another is a patient diagnosed with alcoholic cirrhosis was prescribed with Indomethacin, a drug contraindicated to patient with severe liver damage, was instructed ‘as directed’ regarding the dose, with no instruction on frequency or maximum daily intake.
Serious errors uncovered include prescription of drugs to patients who are already known allergic to a particular drug like Penicillin or Acyclovir; continuation of Warfarin to a 93 year old patient who missed three consecutive INR blood sampling appointments. Warfarin is a blood thinner that increased risk of bleeding. Patient should have regular INR appointments to determine the drug level and adjust Warfarin dosage accordingly.
The study identified several risk factors for prescription errors such as GPs poor therapeutic training, lack drug knowledge and experience, knowledge of the patient, complexity of patient’s case, poor communication between GPs and nurses, high-workload, time-pressures, failure of blood-test monitoring and without access to INR results, lack of familiarity of computer systems like selecting wrong drug or wrong dosage instructions from pick lists, ambiguous wordings in the correspondence from specialists to GPs.
Human error was behind most mistakes. Incomplete information on the prescription, followed by problems with dose and timing of doses are the most common type. GPs pointed out that nurses also sometimes interrupted them during clinics which led to errors.
Proposed solutions
GPs need proper training, drug knowledge and experience. GMC advises doctors to be familiar with the current guidance published in the British National Formulary (BNF) before prescribing medicines.
Prescribing unfamiliar drugs is the most problematic. Study cites that some GP “just go ahead anyway instead of stopping a moment, checking the BNF to see what it says, and then following the advice”.
Prof Avery concluded in a study published in Lancet this February that in-house pharmacists can help GPs reduce prescribing errors by up to 50 percent. Martin Astbury, president of the Royal Pharmaceutical Society, supports the application of Prof Avery’s findings.
Dr. Brian Hope, a GP interviewed today in BBC concurred about in-house pharmacists’ benefits, “It’s a little bit like Tesco. You do the shopping and then you go to check-out. It’s good to have those two processes go together, and it’s the same way as prescribing. I prescribe and they dispense. Having two people or systems checking can be very effective way…so if I do make an error of putting slightly the wrong dosage, they will check it out before it goes out.”
Complexity of computer systems overwhelms GPs. Dr. Hope said “GP is often given a computer system. But what we don’t do is actually have the training behind that and the back behind it to say this is the best use of that system…What we do is give a lot hardware but don’t give back-up to the software and the training which will be hugely beneficial”.
Professor Sir Peter Rubin, GMC chairman, sums up some important solutions. He said GPs had to give prescribing priority, greater involvement from pharmacists and effective computer systems.
Despite of these prescription errors, Chair of Royal College of GPs Dr Clare Gerada said that of one million daily consultations, “in 95 percent of cases GPs prescribe safely and effectively”.