Of all clinical negligence claims, 20% concern medication errors against doctors in both primary and secondary care, accounting for £750 million per year. Prescribing, and by extension medication errors, can relate to
- the supply of prescription-only medicines;
- prescribing medicines, devices, or dressings;
- advice regarding the purchase of over-the-counter medicine, or information prescriptions.
Drugs or treatment should only be prescribed once a doctor has adequate knowledge of a patient’s condition, and that the prescription will serve the patient’s need. Doctors should avoid prescribing for themselves or anyone close to them, but those with full registration may prescribe any medicine that is not in Schedule 1 of the Misuse of Drugs Regulations of 2001.
Additionally, doctors should be familiar with up-to-date guidance from the British National Formulary – such as the contraindications of various medicines. The cost-effectiveness of medicines should also be considered.
Ultimately, the responsibility if something goes wrong lies with the person who signs the prescription. If a doctor takes advice from someone who does not have prescribing rights, such as a nurse, they must be satisfied that the prescription is appropriate, as the responsibility still lies with them.
The dosage of medicines includes its strength, frequency, and route – of especial importance for prescribing to children.
When checking for contraindications, doctors should ensure their patient is not currently allergic to any of the proposed treatments, does not have an illness that could be worsened by the medication, and is not taking any medication which may interact with the prescription.
Like any other medical procedure, prescribing is still subject to the usual consent guidelines. Doctors should fully inform patients about their condition, their reasons for the proposed treatment, symptoms, and any side effects that may occur. The side effects may be due to contraindications with other drugs – over-the-counter or prescription, or alcohol – and may impede ability to undertake certain tasks, such as driving.
Any following-up or monitoring arrangements should be pre-arranged with the patient. Of particular importance are the conditions under which a patient should return to the doctor, and the problems with failing to honour the agreement.
Despite the prevalence of digital prescriptions, doctors should still try to follow good practice when handwriting a prescription. They should always write in ink, in full words, make any errors very apparent with an initial, and clearly state dosages, strengths, and drug names with clarity and to an appropriate number of decimal places.
All prescriptions need to include the date on which they were produced, as well as the full name and address of the patient – including their date of birth, if they are under 12 years of age. To safeguard false or illegal prescriptions, all blank forms should be securely stored.
Doctors should also endeavour to make a clear record of all prescriptions in the patient’s notes.
Prescribing by Recommendation
General Practitioners will often find themselves being asked to continue a course of prescriptions that began in the secondary care setting. Specialists informing a GP should ensure that they have provided all pertinent information, and GPs should ensure that they receive all relevant information before prescribing – including
- aim of treatment,
- mechanism of action,
- dose and frequency,
- risks and benefits,
- any monitoring that is required,
- potential side effects, and
- what the patient has been told.