While pathologists fret about accreditation GPs demonstrate prescription error rates


Like most people, pathologists want to deliver an excellent service.  Through this desire they have fallen victim to the inspection cartel which has deceived them into believing the bogus claims of accreditation.  As in many other areas, the quality-limiting step may be elsewhere.  Delivering compliance to inspectors in one important area may make no difference to clinical outcomes. 

Poor monitoring and processes are responsible for errors in one in 20 GP prescriptions

BMJ 2012; 344 doi: 10.1136/bmj.e3163 (Published 2 May 2012) Cite this as: BMJ 2012;344:e3163

Ingrid Torjesen

One in 20 prescriptions written by GPs in England contains an error, and one in 550 contains a serious error, a large study has found. The prevalence and causes of prescribing errors in general practice study, commissioned by the General Medical Council, shows that it is not doctors’ knowledge about drugs that is responsible for most errors but human factors and process issues. Errors chiefly occur because of problems in the process of prescribing and failure to monitor and review patients adequately.

Pharmacists reviewed 6048 prescriptions written for 1777 patients by GPs at 15 general practices in England for errors. Most of the 247 prescribing errors and 55 monitoring errors identified were not serious: 42% were minor, 54% moderate, and 4% severe. The most serious related to failure to adequately monitor warfarin or to prescribe a drug to a patient with a documented allergy to it—the two cases of allergy that occurred involved penicillin and

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So, a five percent error rate in GP prescriptions, but Bandolier has reviewed the error rates in clinical biochemistry services also:

“Overall, the rate of blunders seems to be pretty constant at about 0.3% of results (3 per 1000), and the analytical error is perhaps 0.04% (less than 1 per 1000). So blunders do happen in the best regulated systems, so if a result looks wrong, it is probably worth checking….

Many labs have CPA accreditation.  Is this to thank for the good biochemistry results?    Investigators tend not to distinguish the quality of management from “quality” management, but accreditation is not noteworthy:

“…Even so there is a clear message from this important study. In the same circumstances some laboratories do brilliantly, while some are awful. The equipment, the funding, and people probably don’t differ by much. But management and leadership can make a huge difference to quality of service.”

Should GP prescribing be accredited?  Or is the large variation in errors due to the different natures of the work and management culture?

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