S1) Safe Prescribing and Medication Errors

Question 1

What are the three types of problems that lead to medication errors?

Answer 1

• Patient-related problems
• Pharmaceutical problems
• Doctor-related problems

Question 2

Describe two patient-related problems leading to poor prescribing

Answer 2

• Increasing population i.e. patient numbers
• More elderly patients with co-morbidities (renal/hepatic), multiple drugs and increased risk of side effects

Question 3

Describe three pharmaceutical problems leading to poor prescribing

Answer 3

• New drug developments
• Some side effects only occur during post-marketing surveillance
• Blind adherence to guidelines (contraindications / serious interactions)

Question 4

Describe four doctor-related problems leading to poor prescribing

Answer 4

• Increased specialisation
• Increased used of medicines generally
• Increased complexity of medical care
• Exhaustion

Question 5

In three steps, explain how compound errors can occur when prescribing on-call

Answer 5

Errors more likely to occur:

⇒ Rarely know patient

⇒ Prescribe new unfamiliar drugs

⇒ Prescribe old drugs in absence of results

Question 6

Before writing a prescription, what 9 things should one confirm?

Answer 6

• Name of drug(s)
• Dose
• Strength
• Frequency
• Duration of treatment
• Allergies/adverse effects
• Indication
• Adherence
• GMC Guidance

Mnemonic: Now Daniel Says Feathery Ducks Are as Interesting As Goats

Question 7

Identify the seven features of good practice requirements for prescribing drugs

Answer 7

• Approved drug name
• Route of administration
• Dose
• Strength
• Units in full
• Frequency
• Special (additional) instructions

Question 8

What is a serious reaction?

Answer 8

• A serious reaction is any reaction which results in/prolongs hospitalisation
• They can be fatal, life-threatening, disabling or incapacitating