Weekly for daily

23 December 2011

A 73-YEAR-OLD woman, Mrs B, attends a GP surgery to discuss medication for her rheumatoid arthritis. On agreement the GP, Dr K, starts her on a course of methotrexate but in error he writes out a prescription for 10 mgs, 2 daily, when the safe correct dosage is 10 mgs, 2 weekly.

Ten days later Mrs B is admitted to a cardiac unit seriously unwell with atrial fibrillation and flu-like symptoms. The hospital contacts Dr K when it becomes clear there has been an error. Dr K visits Mrs B in hospital and admits his error and expresses sincere regret. In doing so he is following GMC guidance as set out in Good Medical Practice: “Patients who complain about the care or treatment they have received have a right to expect a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology”.

Mrs B seemed to accept his apology and it was hoped that this would be enough. But some time later a letter arrives from Mrs B’s solicitors with a claim for compensation.

Analysis and outcome

As Dr K had also admitted liability in a letter to Mrs B there is no alternative but to settle. In the meantime it transpires that there has been an investigation into procedures at the pharmacy which dispensed the methotrexate. It is acknowledged that the dispensing pharmacist should have noted the incorrect dosage. An agreement is struck with the pharmacy to share the moderate damages and legal costs.

Dr K also initiates an investigation into the practice’s procedures for handling some dangerous drugs which are normally hospital-prescribed. He also looks at ways the practice computer system can be adjusted to make it more difficult for errors to occur in the issuing of daily or weekly prescriptions.

Key points

• Double-check dosage when prescribing unfamiliar drugs.
• Do not rely on pharmacists to always pick up prescribing errors.
• Take advice on the form and content of an apology to a patient if you are unsure if this might imply liability.
• Ensure practice systems are robust enough to minimise the risk of errors in prescribing daily/weekly prescriptions.