Case of the month - Ointment overuse

...There was no evidence to show that the patient had been advised on the proper use of the medication or its side-effects....

A 42-YEAR-OLD male, Mr P, had suffered from eczema from a young age. His local GP surgery had always provided treatment for the condition. Some time prior to age 25 he was prescribed the corticosteroid ointment Dermovate. The exact date of the first prescription was uncertain as Mr P’s records prior to that year had been misplaced. Over the next years he was issued numerous repeat prescriptions for the ointment which he applied mainly to the back of his knees, his elbows but also to his face.

In his early 30s Mr P began to notice redness and thread veins on his cheeks. His colleagues at work and friends also noticed and made comments on his appearance. Mr P attended his GP practice and rosacea was diagnosed. He was prescribed Oxytet and referred to a dermatologist. Mr P later opted for private laser therapy to treat the thread veins and was advised then by the laser therapist not to use Dermovate on his face.

A few years later he attended the GP practice and was seen by a locum. He enquired about a repeat prescription of Dermovate to treat his recurring eczema and explained that he had been using the ointment for years. The locum immediately advised him that long-term, repeated use of the corticosteroid was contraindicated. She prescribed another medication and removed Dermovate from his repeat prescription list.

Analysis and outcome

A claim was later received by the GP practice for negligence in the over prescription of Dermovate. It cited that in the BNF the medication falls under the heading of “very potent topical corticosteroids” and that it should only be prescribed for short-term treatment of severe resistant inflammatory skin. No evidence was present in Mr P’s records that he had been advised on the proper use of the medication or the side-effects.

Mr P had been seen by numerous doctors in the practice over the years and it was a clear case of a “systems error” in which the repeat prescription was never adequately reviewed. The case was deemed indefensible and settled along with all legal costs.

Key points

• Ensure that all repeat prescriptions are adequately reviewed.

• Record any and all discussions with patients regarding use and potential side-effects of medications.

• Be vigilant in the prescribing of steroid ointments.