dr. diarmuid quinlan, gp glanmire

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MEDICAL PROTECTION SOCIETY EDUCATION AND RISK MANAGEMENT Repeat prescribing "None so blind as those....." Copyright 2010 All Rights Reserved Dr Diarmuid Quinlan Clinical risk assessor, MPS November 2014

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Repeat Prescribing 'None so blind as those........

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Page 1: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Repeat prescribing

"None so blind as those....."

Copyright 2010 All Rights Reserved

Dr Diarmuid Quinlan

Clinical risk assessor, MPS

November 2014

Page 2: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Journey

Page 3: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Page 4: Dr. Diarmuid Quinlan, GP Glanmire
Page 5: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Repeat prescribing...deceptively complex

Page 6: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Prescribing errors in general practice – a prospective study

▪ 28 GPs, 3 days: 3948 scripts

▪ 12%contained one or more error. (1 in 8)

▪ 2.4% potentially serious error. ( 1 in 40)

▪ 148 telephone calls to GPs ( 2/GP/day)

▪ Overall error rate = 6.2% per 100 items prescribed

Sayers Y M et al. European Journal of General Practice 2009 1-3

Page 7: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Prescribing errors can be lethal........

.

Page 8: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Page 9: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Page 10: Dr. Diarmuid Quinlan, GP Glanmire

Medication errors are like ghosts…

They will haunt you,

FOREVER!

Page 11: Dr. Diarmuid Quinlan, GP Glanmire

Could it be you?

“There are none so blind

as those who will not see” (Heywood 1546)

Page 12: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

In general practice ….

▪ Approx 20% MPS claims-medication errors

▪ Contraindicated drug▪ Wrong drug▪ Wrong dose

MPS Casebook: Learning from clinical

claims in primary care Vol. 19 no. 3 -

September 2011

Page 13: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Top key risks in UK and Ireland general practice 2013

▪ 100% Communication

▪ 100% Confidentiality

▪ 97.4% Health and safety

▪ 95.4% Prescribing

▪ 89.5% Record keeping

▪ 88.9% Infection Control

▪ 88.9% Staff Training

▪ 88.2% Test results

MPS analysis of CRSAs undertaken during 2013

Page 14: Dr. Diarmuid Quinlan, GP Glanmire

Prescribing risks 95.4%

Page 15: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Professional responsibilities

“Providing medical treatment necessarily involves some

degree of risk

However, you must ensure as far as possible that the

services you provide are safe and comply with the

standards of the professions”

http://www.medicalcouncil.ie/_fileupload/misc/171109%20Final%20Version%20Ethics%20Guide%20Update

%20For%20Printer.pdf

Page 16: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

GMC: United Kingdom

The GMC states:

▪ Para 55 - “You are responsible for any prescription you sign, including repeat prescriptions for medicines initiated by colleagues, so you must make sure that any repeat prescription you sign is safe and appropriate.”

▪ Para 57 - “You must be satisfied that procedures for prescribing with repeats and for generating repeat prescriptions are secure.”

Good practice in prescribing and managing

medicines and devices (January 2013)

http://www.gmc-uk.org/Prescribing_Guidance

Page 17: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Monitoring of toxic medications

▪ Ireland has four timesmore adverse methotrexate events than UK

Delaney T (2011) Safe treatment with oral

methotrexate HSE

Page 18: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Reduce the risk…

▪ Specify 2.5mg tabs only

▪ Specify day of week

▪ Do the blood test / issue the script

▪ PATIENT HELD SAFETY CARD

▪ Undertake an audit

▪ Patient safety UK has useful information:

http://www.nrls.npsa.nhs.uk/resources/?entryid45=59800

ALERT

This patient is currently on

IMMUNO SUPPRESSING

DRUG TREATMENT.

If you feel unwell, or have a fever,

sore throat, easy bruising, bleeding,

mouth ulcers, shivering see a

doctor urgently & request an

urgent blood test. Consider

NEUTROPENIC SEPSIS (See

overleaf for details)

Page 19: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Medication protocols

▪ Legislation .....

▪ Written directions

▪ Authorisation of the nurse, by the GP

▪ Prescription not required when a medication protocol is in effect

▪ Supported by An Bord Altranais

http://www.nursingboard.ie/en/homepage.aspx

Page 20: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Exercise

In small groups, identify medicines management risks and some possible solutions for those risks, associated with repeat prescribing

▪ Please use the template provided

1. Chart how a patient initially requests a repeat medication andfollow the journey through the system to the end process ofobtaining the medication

2. Identify bottlenecks/risks within the repeat prescribing system andwhere duplication takes place

3. Are there any steps in the system that could be simplified orchanged to make the system safer and save time?

▪ Be prepared to share your answers with the larger group

Page 21: Dr. Diarmuid Quinlan, GP Glanmire
Page 22: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Repeat prescribing – don’t repeat the risk

▪ Repeat prescribing in your practice................?

▪ high quality, seamless & safe service Or

▪ high-risk, error prone & ‘ad hoc’ activity?

▪ Make sure your repeat prescribing is a ‘win-win’ situation

▪ MPS repeat prescribing workshop

Page 23: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT

Thank you, and...

Dr Diarmuid Quinlan

http://www.medicalprotection.org/uk

Page 24: Dr. Diarmuid Quinlan, GP Glanmire

MEDICAL PROTECTION SOCIETY

EDUCATION AND RISK MANAGEMENT