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Another tool for protecting patients

I have just finished reading the updated General Medical Council guidance on good prescribing practice. One section that stood out for me was concerned with harm caused by prescribing errors. The guidance acknowledges that harm can be, and usually is, avoided if professional colleagues intervene before an error reaches a patient and, furthermore, emphasises the importance of protecting patients from harm by challenging poor prescribing practice.

A few years ago I came across an issue where a consultant had prescribed a warfarin loading dose regimen that finished on a bank holiday weekend. This meant there would be no anticoagulation service available to monitor the patient’s international normalised ratio — putting the patient at risk. Because the patient had already started treatment, we had to put a special management plan in place to mitigate the situation.

I informed the consultant of the issue, highlighting the need to adapt warfarin loading dose regimens to fit individual circumstances. He was receptive to the advice and we had a good discussion on how to manage these situations. We also discussed how a pharmacist independent prescriber could challenge and improve prescribing practice.

This resonates with the GMC guidance on good prescribing; as pharmacists we have always challenged poor prescribing to protect patients from medicines-related harm, but as more of us become prescribers we now have another way of facilitating this role.

In my discussion with the consultant we determined that pharmacist prescribers are best suited to take the lead on the prescribing of all newly started anticoagulants. Traditional roles in clinical checking are still valid; however, as a prescriber I can now intervene proactively. There is still a risk of error and I also rely on colleagues to challenge my own prescribing practice.

As a profession, pharmacists can use prescribing as a tool to challenge poor practice and protect patients from harm, which complements our traditional reactive role of intervening before an error reaches a patient.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11123342

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