GP prescribing ‘could be improved by IT’

Better use of computer systems in general practice could reduce errors in GP prescribing, which are currently found in one in 20 prescriptions, a major study has recommended.

An investigation of prescribing in general practice commissioned by the General Medical Council, found most errors were classified as mild or moderate, but one in 550 was judged to be serious.

It recommends a greater role for pharmacists in supporting GPs, more effective use of IT in general practice, and extra emphasis on prescribing in GP training to address the issue.

Professor Sir Peter Rubin, chair of the GMC, said GPs were typically very busy so it was important to make sure that prescribing was given the priority it needed.

He added: “Using effective computer systems to ensure potential errors are flagged and patients are monitored correctly is a very important way to minimise errors.”

The PRACtICe study (Prevalence and causes of prescribing errors in general practice) is the largest study of its kind.

It looked at 6,048 unique prescribing items for 1,777 patients from 15 GP practices. It reviewed errors using interviews with prescribers, root cause analyses and focus groups with primary health care team members.

It found the most common errors were missing information on dosage, prescribing an incorrect dosage, and failing to make sure that patients got necessary monitoring through blood tests.

The report recommends that practices develop strategies to make the best use of the safety features that are already present on their systems.

It said the GMC should also discuss the outcome of the study with organisations with a remit for quality assurance including the Royal College of GPs and the General Pharmaceutical Council.

These discussions should cover whether improvements could be made in the training of GPs and practice staff to make the best use of prescribing features in GP computer systems.

The report also says that consideration should be given to the use of pre-specified ‘order sentences’ to encourage prescribers to provide appropriate dosage instructions. It adds that context-specific dosage guidance could be provided, taking account of patient factors such as age and renal function.

The authors say consideration should also be given to alerts for blood test-monitoring for certain drugs and for the most common and important examples of hazardous prescribing.

These alerts would be in addition to drug-drug interaction alerts, which are already present on all GP clinical computer systems in the UK.

The report outlines other strategies that could be used to improve use of IT. These include avoiding similar drug names being adjacent in pick lists, running searches on clinical records systems to identify potential prescribing errors and patients requiring blood-test monitoring, and familiarising locums with health information technologies available in practices.

Professor Tony Avery from Nottingham University’s medical school who led the report said prescribing was a skill and one that doctors should take time to develop and keep up to date.

He added: “Few prescriptions were associated with significant risks to patients but it’s important that we do everything we can to avoid all errors.

“GPs must ensure they have ongoing training in prescribing and practices should ensure they have safe and effective systems in place for repeat prescribing and monitoring.”