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Repeat Prescribing 'None so blind as those........
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MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Repeat prescribing
"None so blind as those....."
Copyright 2010 All Rights Reserved
Dr Diarmuid Quinlan
Clinical risk assessor, MPS
November 2014
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Journey
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Repeat prescribing...deceptively complex
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Prescribing errors in general practice – a prospective study
▪ 28 GPs, 3 days: 3948 scripts
▪ 12%contained one or more error. (1 in 8)
▪ 2.4% potentially serious error. ( 1 in 40)
▪ 148 telephone calls to GPs ( 2/GP/day)
▪ Overall error rate = 6.2% per 100 items prescribed
Sayers Y M et al. European Journal of General Practice 2009 1-3
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Prescribing errors can be lethal........
.
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Medication errors are like ghosts…
They will haunt you,
FOREVER!
Could it be you?
“There are none so blind
as those who will not see” (Heywood 1546)
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
In general practice ….
▪ Approx 20% MPS claims-medication errors
▪ Contraindicated drug▪ Wrong drug▪ Wrong dose
MPS Casebook: Learning from clinical
claims in primary care Vol. 19 no. 3 -
September 2011
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Top key risks in UK and Ireland general practice 2013
▪ 100% Communication
▪ 100% Confidentiality
▪ 97.4% Health and safety
▪ 95.4% Prescribing
▪ 89.5% Record keeping
▪ 88.9% Infection Control
▪ 88.9% Staff Training
▪ 88.2% Test results
MPS analysis of CRSAs undertaken during 2013
Prescribing risks 95.4%
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Professional responsibilities
“Providing medical treatment necessarily involves some
degree of risk
However, you must ensure as far as possible that the
services you provide are safe and comply with the
standards of the professions”
http://www.medicalcouncil.ie/_fileupload/misc/171109%20Final%20Version%20Ethics%20Guide%20Update
%20For%20Printer.pdf
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
GMC: United Kingdom
The GMC states:
▪ Para 55 - “You are responsible for any prescription you sign, including repeat prescriptions for medicines initiated by colleagues, so you must make sure that any repeat prescription you sign is safe and appropriate.”
▪ Para 57 - “You must be satisfied that procedures for prescribing with repeats and for generating repeat prescriptions are secure.”
Good practice in prescribing and managing
medicines and devices (January 2013)
http://www.gmc-uk.org/Prescribing_Guidance
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Monitoring of toxic medications
▪ Ireland has four timesmore adverse methotrexate events than UK
Delaney T (2011) Safe treatment with oral
methotrexate HSE
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Reduce the risk…
▪ Specify 2.5mg tabs only
▪ Specify day of week
▪ Do the blood test / issue the script
▪ PATIENT HELD SAFETY CARD
▪ Undertake an audit
▪ Patient safety UK has useful information:
http://www.nrls.npsa.nhs.uk/resources/?entryid45=59800
ALERT
This patient is currently on
IMMUNO SUPPRESSING
DRUG TREATMENT.
If you feel unwell, or have a fever,
sore throat, easy bruising, bleeding,
mouth ulcers, shivering see a
doctor urgently & request an
urgent blood test. Consider
NEUTROPENIC SEPSIS (See
overleaf for details)
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Medication protocols
▪ Legislation .....
▪ Written directions
▪ Authorisation of the nurse, by the GP
▪ Prescription not required when a medication protocol is in effect
▪ Supported by An Bord Altranais
http://www.nursingboard.ie/en/homepage.aspx
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Exercise
In small groups, identify medicines management risks and some possible solutions for those risks, associated with repeat prescribing
▪ Please use the template provided
1. Chart how a patient initially requests a repeat medication andfollow the journey through the system to the end process ofobtaining the medication
2. Identify bottlenecks/risks within the repeat prescribing system andwhere duplication takes place
3. Are there any steps in the system that could be simplified orchanged to make the system safer and save time?
▪ Be prepared to share your answers with the larger group
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Repeat prescribing – don’t repeat the risk
▪ Repeat prescribing in your practice................?
▪ high quality, seamless & safe service Or
▪ high-risk, error prone & ‘ad hoc’ activity?
▪ Make sure your repeat prescribing is a ‘win-win’ situation
▪ MPS repeat prescribing workshop
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT
Thank you, and...
Dr Diarmuid Quinlan
http://www.medicalprotection.org/uk
MEDICAL PROTECTION SOCIETY
EDUCATION AND RISK MANAGEMENT