Prescribing malpractice pitfalls are easier to fall into than you might think—wrong dose levels or mistaken drug names are just the beginning.
Arm yourself with the knowledge you need to provide the best care for your patients by avoiding the 7 most common issues listed below.
1) The Prescription
The “big 5” of a prescription are the most important and also the source of some of the worst mistakes.
- Patient – check full name, address, date of birth and NHI
- Dose level
- Timing (frequency and duration)
If giving out a prescription, double-check that each of these five are accurate and coherent. These are also the five factors that should be top-of-mind during prescription reviews (including the 3-month checks for long-term illnesses).
A mistake in any of these could result in adverse drug reactions.
Monitor plasma concentrations or biomarkers to ensure the patient is following the parameters of the prescription, and that the prescription is resulting in the expected outcome(s).
2) Unintended omissions
Sometimes prescriptions are inaccurate not because of what is there, but of what is not there.
Unintended omissions like failing to put an end-date for a repeated course of treatment, or an inadequate evaluation of potential harm for that particular patient—especially when dealing with drugs that may cause dependency—can cause problems for future prescriptions (and the doctors prescribing them).
Repeat prescriptions should always include the number of repeats on the prescription itself, and every prescription should have a dispensing frequency. If it doesn’t, it’s open to abuse or misuse by the patient.
3) Inaccurate taking of medication history
Writing a prescription relies on knowing previous and current medical issues and associated treatments, as well as patient behaviour in regards to adherence to the treatment. This information can be found by checking the patient’s medical records (assuming they have been well-kept).
If in doubt, consulting TestSafe or the regularly dispensing pharmacist of previous medications can be a good idea. This ensures that patients are using the prescribed treatments as they should and as frequently as they should.
4) Patient sharing
If you prescribe a new medicine to a patient who you share the care of with another doctor, the other doctor needs to be informed as soon as possible.
As the prescribing doctor, you will be responsible for that prescription and its effects, but your colleague(s) will need to know as well to ensure they are aware to keep an eye out for adverse reactions or drug interactions.
While every prescription needs your full attention, any prescription that features drugs which can interact with previous or current treatments requires special care.
This is particularly common when the primary medicine has side effects that are then treated with additional medication.
Communication with previous healthcare providers is valuable here as it may allow you to expand on existing medical records if required. Ideally, you will be able to create a list of previously prescribed medications (and current) and be able to link them to individual disease states.
Any prescription you make should fill gaps in the patient’s healthcare landscape, rather than treating illnesses that are already being treated. Adding unnecessary alternative treatments merely increases the chance for adverse side effects or interactions.
6) Over-complicated prescriptions
Prescribing is one thing; adherence is another. About 50 per cent of patients do not take their prescribed drug correctly, either doing so irregularly or not at all. This is often due to symptoms disappearing, side effects, feeling like the drug isn’t working or getting frustrated with the dosage schedule.
This last reason is one that you can easily resolve at the prescription level. Avoid more complicated treatments when a more simple one will do. Aim for:
- As few drugs as possible (preferably one),
- As few potential side effects as possible,
- As simple a dosage form and schedule as possible, and,
- As short a duration as possible.
7) Error reporting
One of the biggest pitfalls of prescription errors is failing to report them.
The Medication Error Reporting Programme (MERP) is operated by the New Zealand Pharmacovigilance Centre. The MERP collects reports of errors to supplement, contribute to and improve the safe use of medicines.
The MERP is an online, national, voluntary, no-blame reporting system designed to help identify hazards and risks in prescribing that will allow doctors to learn from these issues and avoid them in the future, including:
- Product labelling
MERP operates alongside the Centre for Adverse Reactions Monitoring (CARM).
For more information on avoiding common errors as a doctor in training, download our free ebook below!