12 • Advice


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From similar-sounding names to illegible handwriting, GPST editor Dr Susan Gibson-Smith highlights the most common prescribing risk areas


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RESCRIBING is a common task for GPs but it is one in which even a simple error can have serious consequences.


Consider the following scenario: The mum looked exhausted. She had been struggling to breastfeed for two months but it was becoming increasingly


difficult with the vomits and the crying. The health visitor said it was reflux and to try ranitidine, but had not specified a dose. The BNF wasn’t much help and I was feeling pressured. I checked the paediatric BNF and saw the dose for a child 1–5 months was 1 mg/kg three times daily (max. 3 mg/kg three times daily). The baby was crying and mum seemed annoyed I was taking so long. She told me the baby weighed 7.5kg so I gave her the prescription for 5ml three times a day as there was 75mg in 5ml. I was pleased at being able to work out the solution without having to ask anyone, and mum was happy that she had a medicine to help. Later that afternoon the pharmacist called to say I had prescribed 10 times the recommended dose of ranitidine and that mum was very upset. How could this have happened?


Around 14 per cent of all GP claims handled by MDDUS relate to prescribing, from confusing similar-sounding drug names and mixed-up


doses to failing to follow General Medical Council guidance. As a trainee GP, it is crucial to be aware of the most common prescribing pitfalls.


Patient names Take care to check that the computer record you have open is for the correct patient. This may sound basic, but on a busy day it can be easy to confuse Mary Smith (DOB 21/5/42) with Mary Smith (3/10/51). Always check with the patient that they are who you think they are.


Generic or brand We are all taught as medical students to prescribe generically but there are times when it is more appropriate to prescribe a brand name medicine. One key example is for patients with epilepsy where using the branded drug (e.g. Epilim) can be crucial to ensure the correct drug is given. Care should always be taken with HRT prescribing as a common mistake is to give a patient unopposed oestrogen instead of combined as the names can be confusing. It is also important to note that brand name prescribing is sometimes cheaper than generic if the drug has come off patent. An example of this would be Longtec instead of the generic oxycodone. It is advisable to regularly check your CCG/health board’s formulary to make sure you are up-to-date with the latest changes.


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