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Thousands of patients 'at risk from asthma prescribing errors'

  • 8 Comments

Almost 23,000 people with asthma may have been unsafely prescribed medication for their condition in recent years that puts them at a higher risk of death, according to data analysis by a charity.

Asthma UK’s review of sample GP data from 2010 to 2013 suggested that almost 21,000 adults and 2,000 children across the UK may have been given long-acting reliever inhalers alone – instead of in combination with the required inhaled steroids.

“It is crucial that healthcare professionals urgently recall patients who have been prescribed long-acting reliever inhalers on their own”

Kay Boycott

The charity described such prescribing as “unsafe”, “unlicensed” and as “putting the lives of patients at risk”.

It made the claims today in a report called Patient Safety Failures in Asthma Care: the scale of unsafe prescribing in the UK.

The data on almost 95,000 people across more than 500 GP practices also found that in an “unacceptably common” number of cases patients were prescribed more than the maximum of 12 reliever inhalers per person a year.

In addition, nearly 40% of the 5,000 people in the data sample that had been prescribed more than 12 reliever inhalers in a year had not been reviewed by a healthcare professional.

Asthma UK said that when applied to the UK population, this indicated almost 107,000 people with asthma may have been prescribed excessive amounts of reliever medication without a review.

This number potentially included 10,000 children under the age of 15, putting them at higher risk of a life-threatening asthma attack.

“Correct training is crucial and should encompass diagnosis, the understanding of asthma guidelines in practice, and the best evidence for long term treatment”

Matthew Hodson

The report noted that there may be legitimate reasons for prescribing more than 12 reliever inhalers – such as children requiring spare devices for school.

But it added: “Systems should be in place which alert doctors, nurses and pharmacists to these prescribing patterns, to help them identify whether people are at high risk and need an urgent review, or whether their need for multiple inhalers is valid.”

Asthma UK pointed to a lack of training and education, inadequate systems for identifying and preventing human errors, and a culture that fails to acknowledge the seriousness of asthma as possible reasons for the prescribing errors.

It has urged healthcare professionals to implement recommendations from the National Review of Asthma Deaths, which took place last year, “as a matter of urgency” to protect people with asthma in the UK from avoidable harm and preventable deaths.

Kay Boycott, chief executive of Asthma UK, said: “The UK has some of the highest mortality rates for asthma in Western Europe and the levels of unsafe prescribing identified in our report today must be stopped.

Asthma UK

Kay Boycott

“It is crucial that healthcare professionals review their systems and urgently recall patients who have been prescribed long-acting reliever inhalers on their own without a steroid preventer, or not as a combination inhaler.”

The Association of Respiratory Nurse Specialists and the Royal College of Nursing said the report demonstrated the need for employers to ensure better provision of training for nurses and other primary care staff.

Matthew Hodson, ARNS chair, said: “Correct training is crucial and should encompass the correct diagnosis, the understanding of asthma guidelines in practice, and the best evidence for long term treatment.

“Respiratory nurses have a role to support this but so much of asthma care is undertaken in primary care that all staff have a responsibility to ensure evidence-based care is followed and all employers should ensure that staff can access asthma training,” he said.

Peter Carter, chief executive and general secretary of the RCN, added: “The role of specialist nurses is vital in supporting better patient and professional education, but the number of specialist nursing posts that have been eroded in recent years is deeply concerning.

“The NHS as a whole needs to ensure that staff have the opportunity to update their skills and knowledge regularly, and should have time to carry out proper reviews of the treatment for all their patients.”

  • 8 Comments

Readers' comments (8)

  • As a Primary Care nurse prescriber, I'm sick of hearing this 'healthcare professional bashing' approach to an age old problem. The patients in my care are invited to attend at least annually for review-some ignore this invitation and will order which inhaler they see fit. We will ALWAYS prescribe a LABA in conjunction with an ICS, either in combination or as seperates. The patient's who do attend are made fully aware of which inhaler does what. The problem here is almost always down to none-attendance for review. We do monitor requests for relievers and the patient is called when there is an over reliance on reliever therapy.The patients themselves must take some responsibility.

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  • I agree with the above, as a primary care nurse I find that the asthmatic patients are difficult to get to engage. It may be that they are prescribed more than 12 in a year, but what are we supposed to do? They over order, they are invited to come for a review, they do not attend, but request further medication. Are we to refuse the request and leave them without any medication? As the poster above says people should take some responsibility for their own health with the support of their GPN.

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  • Sad to say that it was forever thus. I've been 'doing ' asthma for donkeys years; I was on course no.2 of the Stratford course when it was officially recognised back in the '80s. I find this all rather depressing to hear the same old thing. Nurses and others work hard in primary care but patients have to meet them half way. I agree with all the above.

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  • I am a chronic asthma sufferer and a nurse. I always attend my asthma review and in all those years I am sad to say I have only really seen one of the practice nurses who made the appointment worthwhile. I do know what to do and am compliant but I have heard so many patients say it is a waste of time. Sadly I think it can sometimes be true. It is definitely due to a lack of interest on both sides and/or training. Our GP refuses to prescribe if you do not attend a review, excellent.

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  • I work in a school and it scares me because often the students or their parents don't understand the full implications of asthma. I often get "they don't need to carry their reliever inhaler because it is only mild, or they have never had a full blown asthma attack."
    I work constantly on careplans for every one of the 178 students that I have with asthma but spend far too much time telling parents to make an appointment for your child's annual review or "they need to take the preventative inhaler everyday, twice a day, not just when they are wheezy."

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  • The post from the asthma suffering nurse only proves the point-if you attend and are compliant, then there is little else to do. Hopefully her asthma is well controlled and she has a management plan in place in order to deal with any exacerbation. It's those people who do not attend, who do not have a plan and do not know what to do that are the cause for concern. I'm sorry if her experience of the asthma review is poor-but it's not supposed to be entertaining.

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  • Thanks but I do know some people who have had a very poor service. I don't expect it to be entertaining and I did say one of the practice nurses was very thorough but all the others are disinterested and cursory in their approach. I was just giving a perspective as a patient which may prove helpful. I am sure those of you responding care passionately about what you do. One of the problems is the general viewpoint from people 'it's only asthma'.

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  • Agree with comment that most nurses care passionately about asthma - the diploma level training is excellent. Over a decade I worked as Respiratory Practice nurse in around 15 practices - all were good. The 'Teamwork' is what really makes for good asthma care - this includes: having good IT system to support consistent messages to the patients; GPs re-enforcing those messages; school nurses liaising with GP Practices; admin staff flagging up patients following hospital admission for urgent review. GP's who withold repeat inhalers are part of the wider approach of good asthma care.

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