Negligence in co-proxamol prescribing

03 June 2009

Forty-year-old Mrs G suffered from chronic back pain for which she was prescribed co-proxamol as an analgesic. She had a history of alcohol misuse and depression, and records showed two previous co-proxamol overdoses whilst under the influence of alcohol. She had been under the care of the local Community Mental Health Team and continued to be seen regularly by her local GP practice.

In January 2005, the Committee on Safety of Medicines issued guidance to all GPs on the prescribing of co-proxamol, in particular highlighting the risk of death in overdose.

The recommendations stated that the prescribing of co-proxamol tablets should be withdrawn altogether over the next 6 to 12 months. Interim prescribing advice pending withdrawal stated that co-proxamol is contra-indicated in:

• Patients who are alcohol dependent or who are likely to consume alcohol while taking co-proxamol.
• Patients who are suicidal or addiction prone.

That February Mrs G consulted with her GP, Dr A, where the issue was fully discussed. Dr A discontinued her co-proxamol and prescribed co-codamol as an alternative. Medical records showed that 5 months later, a further prescription for 100 co-proxamol tablets was issued to Mrs G by the GP practice, although it was unclear as to which practice GP had issued the prescription.

Two months later Mrs G committed suicide. The cause of death was found to be due to a combination of consumed alcohol and co-proxamol. Mrs G was survived by her husband and a teenage son.

A claim was subsequently raised by Mr G alleging negligent practice in the prescribing of co-proxamol. The negligence claim was supported by an expert witness report which cited the 2005 guidance to GPs, Mrs G's past medical history of depression and suicide attempts, and her history of alcohol misuse.

Analysis and outcome

The practice in question consisted of several GPs, and an internal significant event analysis (SEA) was undertaken following the death of Mrs G. This highlighted that although her co-proxamol prescription was discontinued it had not been removed from the repeat prescription list. Later when Mrs G requested a repeat prescription of 100 tablets these were retained by her.

An out of court settlement was agreed in this case. The time between intimation of the claim and settlement was 964 days.

MDDUS figures show that around 13% of GP claims settled in 2007/08 relate to prescribing errors.

Key points

• Ensure discontinued drugs are removed from the practice computer records used to generate repeat prescriptions.
• Avoid having drugs that require close monitoring, such as anti-depressants, on the repeat section of the prescription records.
• Review the prescription management system and procedures to prevent such potential errors.