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Prescribing improved by ‘real life’ language

By Mike Broad - 27th September 2011 9:25 am

The gap between patients and the medical industry needs to be bridged for a more beneficial, effective system of prescribing, a report claims.

N=1: Why people matter in medicine, by the Royal College of Physicians’ medicines forum, highlights the part that patient understanding and belief plays in determining whether or not a medicine is taken as advised, or even taken at all.

The report, based on consultations with patient groups and specialists, makes particular reference to the need for healthcare professionals to use “patient terms” and real life language. The authors say that “conversations need to be derived from what the public wants and needs to know about medicines and their effects - not from what professionals want to tell them”.

The report says there is often uncertainty about what is available to the public in terms of life-changing therapeutic products and what modern medicine is actually able to offer.

A key recommendation of the report is that GPs should be able to refer patients with medication problems to a pharmacist adviser who can also be used as a source of advice for both patients and GPs on medication related issues.

Other practical recommendations in the report focus on more effective engagement, service improvement and improving research for the benefit of the public.

Harry Cayton, chair of the subgroup and chief executive of the Council for Healthcare Regulatory Excellence, said: “Medicines used well do a huge amount of good. Medicines misused, mis-prescribed or misunderstood are either ineffective or harmful.

“There is a great deal of misunderstanding about how medicines work and how they should be used. People’s beliefs about medicines have an enormous and underestimated impact on their use of them in practice.”

Government estimates suggest that the cost of patients not taking their medicines properly is over £500m a year.

Professor Tim Evans, academic vice-president of the Royal College of Physicians, said: “The overall message of this report is that the value of effective use of medicines will not be realised merely by doing more of the same.

“We need a change in approach that relates medicines use to people’s daily lives, acknowledges the importance of concerns about unwanted effects, and radically changes the way we communicate about medicines and information we provide.”

Tags: Prescribing, Therapeutics
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Prescribing incentive schemes are legal, court finds

Healthcare Republic - 23rd April 2010 9:21 am

Prescribing incentive schemes do not breach European law, a judgement by the Court of Justice of the European Union has found.

The court judged that public authorities may offer financial incentives to induce doctors to prescribe cheaper medicinal products. But those authorities must ensure that the incentive scheme is based on non-discriminatory objective criteria. Authorities must also publish therapeutic evaluations relating to the scheme, the court said.

In February, the European Court suggested that prescribing incentive schemes could be illegal. The court argued that such schemes may breach EU directive 2001/83, which prohibits promotion of medicinal products by gift. A ruling had been sought following a case brought by the Association of the British Pharmaceutical Industry against the MHRA.

Nurses allowed to prescribe unlicensed medications

Pulse - 8th January 2010 7:12 pm

Nurses and pharmacists can now prescribe drugs outside their licensed indications and even unlicensed medications after new legislation came into force this month.

From 1 January, nurse and pharmacist independent prescribers can prescribe patients medicines ‘for use outside of their licensed indications’.

The law also now permits them to prescribe ‘unlicensed medicines for their patients, on the same basis as doctors’.

The changes come after a consultation by the UK drugs regulator the Medicines and Healthcare Products Agency, which took place last year.

A working group appointed by the MHRA’s commission on human medicines recommended that ‘it was a logical step to allow nurse and pharmacist independent prescribers to prescribe unlicensed medicines for their patients on the same basis as doctors and supplementary prescribers.’

The commission fully endorsed the working group’s recommendations, and subsequently the Home Office and the Advisory Council for the Misuse of Drugs amended the Misuse of Drugs Act.

GMC calls for a national prescription chart

By Mike Broad - 4th December 2009 12:43 pm

Prescribing errors in hospitals could be reduced if a standardised prescription chart was introduced in all hospitals, the GMC suggested this week.

It comes after research - commissioned by the regulator - reveals that doctors at all levels make prescription mistakes.

The study was prompted by allegations that newly qualified doctors were making a disproportionate number of mistakes. But, when 124,260 medication orders were checked, across 19 hospitals, it was found that 11,077 (or 8.9%) contained errors; the error rate for F1s was 8.4% - similar to that of registrars - while only consultants had a significantly lower rate of 5.9%.

The study shows that the causes of the errors, such as miscalculating the dose, were complex. Some of the errors were due to the system the doctor was working in, including unfamiliar or complex prescribing charts, while others were more straightforward human or communication errors.

Pharmacists often save the day by intercepting and correcting the prescriptions. Senior doctors and nurses also play their part. Consequently, potentially lethal errors were found in fewer than 2% of erroneous prescriptions. Situations included trainees failing to check the patient’s allergies and subsequently prescribing medications which were contraindicated.

Tim Dornan, professor of medicine at the University of Manchester, and research group leader, said: “The research shows the complexity of the circumstances in which errors occur and argues against education as a single quick-fix solution. Education can always be improved but it must be very practically oriented and include all phases of a doctor’s career as well as the undergraduate stage.

“A safety culture was sometimes absent when it came to prescribing and the working conditions of newly qualified doctors were not always conducive to safe practice.”

The GMC recommended that all prescription charts be standardised so that doctors are not confused by the format when they change hospital.

Prof Peter Rubin, chair of the GMC, said: “Prescribing decisions in a hospital setting often have to be made quickly, so it is important that a procedure is as simple as possible to minimise the chance of an error being made.”

Commenting on the study, Dr Karen Roberts, MDU clinical risk manager, said: “Some of the medication errors that we see, such as prescribing a drug to a patient who has a known allergy to it, might be prevented by thorough planning, preparation and communication.”

Read the full study.

Read ten tips on better prescribing.

Tags: Drug errors, Prescribing
Posted in Hospital Dr News | No Comments »

Advice for hospital doctors on avoiding prescribing errors

By Mike Broad - 12:39 pm

A GMC-commissioned study into the writing of prescriptions has revealed an error rate of 8.9%.

The causes of the errors by hospital doctors, such as miscalculating the dose, were complex. Some of the errors were due to the system the doctor was working in, including unfamiliar or complex prescribing charts, while others were more straightforward human or communication errors.

The GMC has called for a standardised prescription chart to be introduced into all hospitals.

In response, the MDU has compiled ten tips to help hospital doctors avoid medication errors:

1. Explain the details of the proposed treatment and its benefits to patients and provide warnings of the risks involved, any side effects and alternatives to the treatment, in line with GMC guidance.

2. If you are not familiar with a drug you are prescribing, check contraindications and side-effects and remember that you take legal responsibility for any prescription you sign.

3. Check the identity of patients during each consultation and ensure you have the correct patient records.

4. Check for known allergies or hypersensitivities and ensure these are always clearly documented in the records, in a place that is obvious to all those involved in the care of the patient.

5. Be particularly careful when prescribing medications with similar names or administering medication with similar packaging to another drug and ensure that you follow appropriate checking procedures before administration. Ensure any complex dose calculations are double checked and take care with medication that is administered by an unusual route, or at an unusual frequency.

6. Ensure patients on repeat medications are reviewed and monitored regularly and that if care is shared with the patient’s GP it is clear who is responsible for follow up and monitoring. The GP should be given all the necessary information about the patient, the condition, the required dose regimen and frequency of the medication to be prescribed, and appropriate follow-up arrangements.

7. Discharge letters should include unambiguous information about how regularly patients should take their medication and the dose, and patients should be given information about what to do if they experience any side-effects.

8. When carrying out high-risk procedures, such as intrathecal chemotherapy, it is essential to ask a colleague to provide an independent check and to follow any hospital protocol in this regard.

9. Be aware of and use the hospital adverse incident reporting system so that lessons can be learned from any mistakes or near misses that do occur. If you are an independent practitioner ensure that you have such a system in place.

10. Record and highlight any adverse reactions in the patient’s notes and ensure these are highlighted during handover meetings. Also report any new adverse drug reaction to the MHRA on the appropriate form.

Read the full findings of the GMC report.

Tags: Drug errors, Prescribing
Posted in Guidance | 1 Comment »

Paramedics may get powers to prescribe drugs

The Guardian - 14th October 2009 11:39 am

Paramedics could be given greater powers to dispense drugs under an initiative to redesign emergency services and keep patients at home.

The change was proposed as the Department of Health released fresh figures today showing that demand for ambulance services is rising at 6.5% a year, adding an extra £60m to the NHS budget each year.

Sending out paramedics with greater skills to deal with patients so that they do not need to be admitted to hospital would be a better way of spending scarce financial resources, the first ever Ambulance Service Network conference was told.

“Ambulance Services received over 7 million 999 calls last year,” said Liz Kendall, the director of the Ambulance Service Network, part of the NHS Confederation.

“The number of calls is increasing by around 6.5% annually - that’s 300,000 more patients every year. Many of these patients are older people who have fallen and patients with chronic conditions who could be better cared for in the community or at home.

“The system isn’t working as well as it should…The government is looking at whether it’s right for paramedics to be able to prescribe medicines, something that would help keep patients in the community.”

Generic drug substitution plans to be consulted on

Healthcare Republic - 26th August 2009 3:29 pm

Proposals to introduce generic substitution will be put out to public consultation, it has been revealed.

Earlier this year the BMA’s GPC prescribing lead Dr Bill Beeby expressed concern when it was revealed that there might be no formal public consultation or parliamentary debate ahead of the introduction of any scheme.

The DoH has now agreed to conduct a full, formal consultation on arrangements for implementing generic substitution, which GPs have suggested could affect patient care.

The proposals to allow pharmacists to substitute drugs prescribed by brand with generic replacements were set out in the changes to the Pharmaceutical Price Regulation Scheme (PPRS) agreed last year.