| Communication problems between patients and GPs | |
| Pt25 | GP prescribed verapamil and atenolol together | “…about 6 months ago, when me blood pressure was high, he says, ‘I’ll give you another tablet.’ Well, I thought I’d only got one, so I says, ‘that makes two’, he says, ‘that should make three.’ I said ‘Oh, right.’ I don’t argue with doctors.” |
| Phrm5 | Patient did not remain upright for 30 min after taking alendronate | “Maybe one tends to think when asthmatic patients are on a lot of medication to control their asthma that somebody along the line, whether it be the practice nurse, hospital, GP, would have told her why she was taking these things.” |
| Pt15 | Patient did not receive medication instructions | “I can’t hear. She knows that. She speaks up loud, but I say, ‘I still can’t hear you doctor.’” |
| Communication problems between pharmacists and GPs | |
| Phrm20 | Pharmacist did not query aspirin-rofecoxib combination with GP | “The doctors might not like us to keep ringing them. Sometimes it’s obvious I can tell you, very obvious. So, I don’t know, what can you do about that? You can’t change the prescription for him, you can’t change the attitudes of the doctors because they like to prescribe this way.” |
| Communication problems between primary and secondary care | |
| Case27 | GP prescribed rofecoxib to 82-year-old with chronic renal failure | Outpatient letter informing GP of patient’s diagnosis of chronic renal failure, and advising need for caution with non-steroidal anti-inflammatory drugs, arrived 2 months after clinic appointment (and after GP had prescribed rofecoxib). |
| GP12 | GP did not monitor urea and electrolytes (U&Es) often enough in patient taking metolazone | “All I knew was what we were told which was check it on a weekly basis.” |
| Discharge letter said “Monitor U&Es closely”. |
| GPs’ knowledge gaps about patients’ medication and medical histories | |
| GP21 | GP did not enter prescription for co-amilofruse on computer | “And it should have been, that’s not actually on here is it? And I should, I mean what one hopes one does erm, is, what one hopes one does is then add that to the medication as an outside prescription. So it’s one that I clearly didn’t.” |
| GPs’ knowledge gaps about drugs | | |
| GP27 | Computer system did not alert to risk with prescribing rofecoxib in chronic renal failure | “…the computer does warn us at times, but clearly, not that time.” |
| GP5 | (Not directly related to Case 5) | “Most GPs, I think you’ll find, have a formulary of about 500 drugs they use regularly, you don’t need to look up.” |
| Pharmacists’ knowledge gaps about patients’ medication and medical histories | |
| Phrm27 | Pharmacist did not query prescription for rofecoxib 50 mg in 82-year-old patient | “if you’ve not got the full picture it’s not always the best sort of thing to do, they might not take too kindly to you know, you interfering if you’ve not got all the details.” |
| Pharmacists’ knowledge gaps about drugs | |
| Phrm25 | Pharmacist did not query verapamil-atenolol combination with GP | “[The interactions] are printed out with the dispensing labels, it doesn’t flash up on the screen.” |
| Phrm6 | Patient not counselled about risk of stomach bleeding with aspirin | “Well to be honest I can’t believe that it’s happened from a 75 milligram aspirin. I find that quite amazing because you think, ‘Oh it’s only a low strength.’ You don’t think it’s going to do that kind of damage really.” |