Welcome to Safer Prescribing
A Little About Me
I am a Clinical pharmacist with 15+ years’ experience in various sectors of pharmacy practice including Community, CCG and GP practices. From prescribing linked funding through face to face consultations within GP practice to handing out medication to patients/carers, I have seen it all. This has helped me appreciates challenges at these interfaces and has led to an initiative to design a system for safer prescribing. My ambition is to develop a system that empowers the prescribers to feel confident and has sustainability that does not rely on how experienced or inexperienced a prescriber may be. The results of introducing a pragmatic safer prescribing model had been outstanding and recognised by National Institute for Health and Care Excellence (NICE) Oct 2019.
Why safer prescribing should be a priority?
71.0% of 66 million potentially significant errors per year occur in primary care (published Feb 2018).
50.7 million of these are related to prescribing in primary care
Over a third of avoidable admissions due to adverse drug reactions are linked to NSAID, anticoagulants and antiplatelet. And half of those are due to GI bleed.
Definitely avoidable adverse drug reaction cost NHS £98.5 Million/year and directly responsible for approximately 700 deaths.
World Health Organisation (WHO) launched a third global Patient Safety Challenge, Medication Without Harm, in 2017. This aims to reduce global burden of severe and avoidable medication errors by 50% in 5 Years.
An efficient prescribing system that incorporates innovative ways to prescribe safely and fills the voids of communication amongst members of multidisciplinary team is at heart of Practice prescribing protocol.
In 2019/2020 new QOF indicators have been introduced to gauge safer prescribing of certain high risk drugs (Lithium, NSIAD and Valproate). These indicators are subject to change on a yearly basis. Having a good insight into prescribing decisions and robust system in place to demonstrate prescribing security will be an ongoing requirement for all GP practices.
Within GP practice the critical points where errors may happen
Missed drugs following hospital discharge
Continuing medication that had been stopped by hospital
Dosage adjustments not followed up after initiation in hospital/primary care
Repeat prescribing for medication without recommended monitoring been checked
When more than one strengths of given dosage form prescribed but total dose is not stated on dosage instructions e.g. Daily dose of Levothyroxine 125mcg prescribed as Levothyroxine 100mcg tablets and 25mcg tablets with dosing instruction of one daily on both drugs
Short term treatments prescribed that interact with regularly prescribed high risk medication. For example antibiotics with Warfarin, Clarithromycin with stat
Replacing existing medication with an alternative but not removing the previous drug from repeat prescribing list
An allergy status not reflective of patient’s current allergies.
Prescribing of multiple drugs that can lead to an unintentional harm such as Serotonin Syndrome due to co-prescribing of SSRI, Opiate, Tramadol and amitriptyline.
Prescribing a dose that does not match patient’s physiological state. Such as paediatrics, pregnant ladies, elderly, hepatic impairment, renal impairment, genetic metabolic disorders (e.g. G6PDH-deficiency, Porphyria)
Bespoke clinical audits (CQC, Quality improvement domain of QOF)
MHRA alerts implementations (CQC)
Help with DNP lists (CCG initiatives)
Antimicrobial prescribing clinical audits (Antimicrobial Stewardship, CCG, Good prescribing initiative)
EMIS web training for Clinical staff
Effective DOCMAN documentation