Article Figures & Data
Figures
- Figure 1. Flowchart showing number of consultations reviewed, prescription items reviewed, and a breakdown of prescribing problems
Tables
Definition of prescribing error, suboptimal prescribing, and legal problem as outlined in the PRACtICe study.3 List of prescribing problem areas that errors and suboptimal prescribing can be attributed to Drug classification by formulation type Drug status — how was it prescribed within the consultation? Prescribing error: ‘A clinically meaningful prescribing error occurs when, as a result of a prescribing decision or prescription writing process, there is an unintentional significant reduction in the probability of treatment being timely and effective or
increase in the risk of harm when compared with generally accepted practice’.
Unnecessary drug
Incorrect drug
Duplication
Allergy error
Contraindication error
Interaction error
Dose or strength error
Formulation error
Frequency error
Timing error
Information incomplete
Generic or brand name error
Omission error relating to failure to prescribe concomitant treatment
Inadequate documentation in medical records
Quantity error
Inadequate review
Duration error
Monitoring not requested
Solid oral
Topical
Liquid oral
Inhalers
Eye or ear
Vaginal
Devices
Injections
Rectal
New acute (NA): a newly prescribed acute medication
Re-issued acute (RA): a prescription of an acute medication that had previously prescribed for this patient by any prescriber
New Repeat (NR): a prescription of a medication that was simultaneously added to the patient’s ‘repeat prescription’
Amended Repeat (AR): a prescription of one of the patient’s ‘repeat medications’ that had been amended during the consultation
Re-issued repeat (RR): a prescription of one of the patient’s ‘repeat medications’ that had not been amended during the consultation
Practice characteristics Practices, n (%) Type of practice Dispensing practice 8 (80) Non-dispensing practice 2 (20) Clinical system SystmOne 5 (50) EMIS Web 5 (50) Formulary availability on clinical system Formulary available 5 (50) Formulary unavailable 5 (50) Mean deprivation score based on IMD scorea (SD) 16.4 (9.5) Mean list size (SD) 9392 (2499) GPs-in-training characteristics Participants, n (%) Sex of GP-in-training Male 5 (50) Female 5 (50) Ethnic group White British 5 (50) British Indian 2 (20) British Pakistani 1 (10) Asian (other) 1 (10) Mixed 1 (10) Age range, years 25–29 3 (30) 30–34 4 (40) 35–39 2 (20) 40–49 1 (10) Date of graduation 2004–2009b 5 (50) 2010 5 (50) Country of graduation UK 8 (80) Overseas 2 (20) Stage of training ST2 1 (10) ST3 9 (90) Sex of trainer Male 7 (70) Female 3 (30) IMD = Index of Multiple Deprivation. SD = standard deviation. ST = specialty training. aDeprivation score (IMD 2010; figures from 2012) http://fingertips.phe.org.uk/profile/general-practice/data. Higher IMD scores indicate greater relative deprivation.bOne participant each for year 2004, 2005, 2007, 2008, and 2009.
- Table 3. Proportion of prescriptions reviewed with a prescribing problem by British National Formulary (BNF) chapter, formulation, and drug status
Items reviewed, n (%) Proportion with an error, n (%) Proportion with suboptimal prescribing, n (%) Chapter of the British National Formulary Chapter 1: Gastro-intestinal system 112 (10.9) 5 (4.5) 36 (32.1) Chapter 2: Cardiovascular system 121 (11.8) 2 (1.7) 15 (12.4) Chapter 3: Respiratory system 65 (6.3) 6 (9.2) 22 (33.8) Chapter 4: Central nervous system 201 (19.6) 27 (13.4) 53 (26.4) Chapter 5: Infections 183 (17.8) 27 (14.8) 65 (35.5) Chapter 6: Endocrine system 46 (4.5) 3 (6.5) 25 (54.3) Chapter 7: Obstetrics, gynaecology, and urinary-tract disorders 39 (3.8) 0 (0) 11 (28.2) Chapter 8: Malignant disease and immunosuppression 1 (0.1) 0 (0) 0 (0) Chapter 9: Nutrition and blood 9 (0.9) 1 (11.1) 4 (44.4) Chapter 10: Musculoskeletal and joint diseases 66 (6.4) 4 (6.1) 22 (33.3) Chapter 11: Eye 16 (1.6) 3 (18.8) 13 (81.3) Chapter 12: Ear, nose, and oropharynx 40 (3.9) 2 (5.0) 30 (75.0) Chapter 13: Skin 125 (12.2) 12 (9.6) 61 (48.8) Chapter 14: Immunological products and vaccines 1 (0.1) 0 (0) 0 (0) Chapter 15: Anaesthesia 3 (0.3) 0 (0) 3 (100.0) Total 1028 (100.0) 92 (8.9) 360 (35.0) Items reviewed, n (%) Proportion with an error, n (%) Proportion with suboptimal prescribing, n (%) Formulation type Solid oral 681 (66.2) 44 (6.5) 195 (28.6) Topical 173 (16.8) 14 (8.1) 92 (53.2) Liquid oral 68 (6.6) 24 (35.3) 21 (30.9) Inhalers 48 (4.7) 6 (12.5) 20 (41.7) Eye or ear 30 (2.9) 4 (13.3) 25 (83.3) Vaginal 12 (1.2) 0 (0) 6 (50.0) Devices 11 (1.1) 0 (0) 0 (0) Injections 3 (0.3) 0 (0) 0 (0) Rectal 2 (0.2) 0 (0) 1 (50.0) Total 1028 (100.0) 92 (8.9) 360 (35.0) Drug status New acute (NA) 666 (64.8) 65 (9.8) 271 (40.7) Reissued acute (RA) 84 (8.2) 10 (11.9) 34 (40.5) New repeat (NR) 65 (6.3) 1 (1.5) 17 (26.2) Amended repeat (AR) 3 (0.3) 0 (0) 1 (33.3) Reissued repeat (RR) 210 (20.4) 16 (7.6) 37 (17.6) Total 1028 (100.0) 92 (8.9) 360 (35.0) - Table 4. Distribution of prescribing events by classification type as determined by case law
Prescribing problem Items with an error, n (%) Items with suboptimal prescribing, n (%) Unnecessary drug 5 (5.4) 6 (1.7) Incorrect drug 7 (7.6) 30 (8.3) Duplication 5 (5.4) 13 (3.6) Allergy error 1 (1.1) 0 (0) Contraindication error 3 (3.3) 0 (0) Interaction error 1 (1.1) 0 (0) Dose or strength error 30 (32.6) 39 (10.8) Formulation error 2 (2.2) 15 (4.2) Frequency error 1 (1.1) 2 (0.6) Timing error 0 (0) 15 (4.2) Information incomplete 24 (26.1) 117 (32.5) Generic or brand name error 0 (0) 8 (2.2) Omission error relating to failure to prescribe concomitant treatment 5 (5.4) 7 (1.9) Inadequate documentation in medical records 3 (3.3) 52 (14.4) Quantity error 3 (3.3) 23 (6.4) Inadequate review 2 (2.2) 8 (2.2) Duration error 0 (0) 24 (6.7) Monitoring not requested 0 (0) 1 (0.3) Total 92 (100.0) 360 (100.0)
Supplementary Data
- Bell_BJGPO.2021.0231_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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