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Prescribing top of clinical risk assessments

19 February 2014

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Prescribing continues to be one of the top five risks in general practice based on clinical risk self assessments (CRSAs) from more than 150 practices last year. 

Data from assessments conducted in the UK and Ireland revealed that 95.4% of practices visited had risks relating to the prescribing system. 

Common problems included uncollected scripts, repeat prescribing systems, and administrative staff changing medications on the computer.

According to the Medical Protection Society (MPS) who analysed the data, uncollected scripts accounted for 53% of prescribing risks. 

Julie Price, clinical risk manager at MPS, said: “We found that a number of practices did not have a robust system in place to alert the prescribing doctor to uncollected prescriptions. 

“Clinicians should be able to review uncollected scripts to check whether any further actions is needed as a consequence of non-compliance, this is particularly important when dealing with vulnerable patients.”

MPS advises practices to consider making a note on patients’ records when they have not collected their prescription. This would alert the doctor to possible non-compliance and highlight to patients that a control mechanism is in place.

Half of practices, 50% had poor repeat prescribing protocols. According to the MPS, the Care Quality Commission will be looking to see whether a practice has suitable arrangements. 

Price said: “It is important that practices draw up a comprehensive and robust repeat prescribing protocol that formalises prescribing systems, ensuring that all staff are trained in the procedure and have access to the protocol.”

MPS noted in a small number of practices doctors ask administrative staff to make changes to the repeat prescription screen after hospital discharges. This is risky practice which can lead to errors.

“To avoid errors, ideally the responsible doctor should add the medication to the prescription list. If administrative staff need to change or add medications, it must be closely checked by the doctor afterwards,” Price said. 

“Considerable care needs to be taken to ensure that all the details are correct and that it has been added to the correct patient record. Ultimately the doctor has responsibility for the prescriptions they sign.”

Other prescribing risks identified were around anticoagulant management (33%), prescription errors (29%) and administration staff changing medications on the computer (27%).