Errors 'in 1 in 20 prescriptions'

GPs may be regularly making mistakes when prescribing medicines, according to a high-profile report published today by the General Medical Council. The report found that mistakes in areas such as dosage and timing were common, although it also found that “serious” errors were unusual.

The report has received a great deal of press interest, with The Daily Telegraph reporting that “millions” of prescriptions contain dangerous errors, while the Daily Mail reported that “GP drug blunders” are hitting hundreds of thousands of elderly patients. The study examined over 6,000 prescriptions issued at a range of GP surgeries in England. It looked at factors such as dosage, record keeping and giving patients appropriate check-ups to assess the impact of their medication. Researchers found prescription errors had been made for one in eight patients overall, and four in ten patients over 75 years of age. In all, 1 in 20 prescriptions written featured an error. Of the errors, 42% were judged to be minor, 54% moderate and 4% severe.

In response to the results, the report recommends better GP training on safe prescribing, closer working between GPs and pharmacists and more effective use of computer systems to flag potential mistakes and reduce prescription errors.

The report examined how common prescribing errors are in general practice, what types of errors are made, what causes them and what can be done to prevent them. It also looked at “monitoring errors”, where patients prescribed a particular drug are not given appropriate checks to monitor its effects and side effects. For example, patients prescribed a drug to lower blood pressure might not be given regular blood pressure tests to ensure the problem is being adequately controlled.

Called The PRACtICe Study (PRevalence And Causes of prescrIbing errors in general practiCe), it was published by the General Medical Council (GMC), which is responsible for standards of medical practice in the UK. It was authored by researchers and doctors from a number of academic institutions.

The study looked at both prescribing errors and monitoring errors. Researchers defined a prescribing error as occurring when “as a result of a prescribing decision or prescription writing process … there is a significant reduction in the probability of treatment being timely or effective or an increase in the risk of harm”. Monitoring errors occur when “a prescribed medicine is not monitored in the way which would be considered acceptable in general practice”.

The study took place in 15 GP surgeries from three areas of England, thought to be representative of all general practices. Researchers took a random 2% sample of patients from each practice, giving 1,777 patients in all, which were deemed to be representative of the population.

The medical records of these patients were investigated to identify potential prescribing or monitoring errors. Researchers looked at over 6,048 prescriptions that had been issued in the previous 12 months. The details of all potential errors were discussed by a panel including one GP, a clinical pharmacologist and three pharmacists, to decide whether they constituted an error. The panel also considered how the error should be classified. The severity of errors was judged on a validated 10-point scale, from 0 (no risk of harm) to 10 (death), by a separate panel of two GPs, two pharmacists and one clinical pharmacologist.

The data were then analysed using statistical software.

To investigate the possible causes of prescribing and monitoring errors, and to identify solutions, researchers consulted 34 GPs with prescribing responsibilities to discuss 70 of the errors they had identified, including the most serious ones. They also conducted six focus groups on possible causes, involving 46 members of primary healthcare teams, and undertook an analysis of potential causes (primary healthcare is care generally given at the first point of contact for patients, such as in GP surgeries or community pharmacies).

Researchers also looked at previous studies examining prescribing errors by GPs. They updated a systematic review on the subject and undertook a further systematic review on potential measures that might reduce the potential harms caused when prescribing medication.

The main findings of the recent study are outlined below:

Researchers also found a number of factors associated with increased risk of prescribing or monitoring errors, including:

From their interviews with GPs and focus groups, researchers drew up a number of underlying causes of prescribing and monitoring errors. These included:

The researchers say that despite these concerns, they also found that:

The GMC recommends several strategies to reduce the risk of errors. These include: