Prescription Error For Woman With Respiratory Complaint

Health and Disability Commissioner Morag McDowell today released a report finding a general practitioner (GP) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in the care of a woman who presented with a respiratory complaint.

The woman, aged in her sixties at the time of events, had a history of asthma. She saw her GP after becoming unwell with symptoms of a tight chest, sore throat, and upset stomach.

The GP prescribed the woman with prednisone, a steroid medication, at a dosage of 80mg a day for a week, to be reduced to 40mg a day for another week. However, the woman remained unwell, and the GP extended the length of time she was to take the medication. Following this consultation, the woman began taking 100mg of prednisone a day, believing this to be the GP’s instruction. However, the GP stated that this was not his instruction. The GP saw the woman again after having been told by the medical centre’s practice nurse that she was taking 100mg of prednisone daily. He said that he advised her to reduce the dosage. However, the woman stated that she did not begin reducing her dosage until a GP friend later advised her to do so.

Health and Disability Commissioner Morag McDowell found a number of failures in the care provided by the GP to the woman. These included commencing the woman on a higher than recommended dose of prednisone, failing to measure and record her peak expiratory flow rate, inadequate documentation for his consultations with the woman, and failing to take sufficient care with a prescription.

"[T]hat there was such a divergence in the parties’ understanding of what [the GP] advised [the woman] highlights the need for clear instructions. … [C]lear instructions are vitally important when a medication regimen is at all complicated, and [the GP] should have documented what he told [the woman] about her prednisone dosage."

The GP is now overseas. Ms McDowell recommended that should he return to New Zealand, he should undertake a clinical notes audit and review the New Zealand Asthma Guidelines, and report back on any changes made to his practice as a result. She also recommended that the GP provide a written apology to the woman, and that the Medical Council consider whether a review of his competency is warranted.

Ms McDowell also noted that the New Zealand Formulary (an independent resource that provides clinically validated medicines information for health professionals) provides refined information with respect to steroid use for specific conditions (including asthma), and that this advice is consistent with the New Zealand Asthma Guidelines. The Commissioner encouraged clinicians to use the New Zealand Formulary for accessing up-to-date prescribing information.

To read the full report on case 19HDC01826, visit the HDC website.

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