Medical Matters:Healthcare errors affect one in every 10 patients worldwide, according to the director general of the World Health Organisation (WHO), Dr Margaret Chan.
Launching the organisation's Patient Safety Solutions programme earlier this month, she said that implementing these solutions would help reduce medical injury around the world.
The nine solutions, based on interventions already shown to reduce problems related to patient safety in member countries, include improved hand hygiene, the performance of the correct procedure at the correct body site and proper patient identification.
Two recommendations deal specifically with medication issues: ensuring medication accuracy at transitions in care and a solution called "look-alike, sound-alike medication names", which draws attention to the pitfall of dispensing a drug that has a similar name to another medication, albeit one with a completely different mode of action and indication for use.
Although computer-generated prescriptions have eradicated the problem of poor doctor handwriting, general practitioners still rely on their community pharmacist colleagues to pick up "sound-alike" medication errors.
Indeed, a good relationship between the community pharmacist and the local doctor works both ways to benefit the patient: the doctor's diagnostic skills and detailed knowledge of the person's medical history complements the pharmacist's comprehensive training in the side effects and interactions of drugs.
However, I am concerned at the call by the Irish Pharmaceutical Union (IPU) at its recent annual meeting for more medicines to be available without prescription. It said the deregulation of certain medicines would enhance patient care and save time and money for patients.
Among the drugs which pharmacists would like to see deregulated are the morning-after pill, statins to lower cholesterol, aspirin for the prevention of heart disease and stroke, and anti-fungal medication to treat thrush.
Although pharmacists were careful not to use the term "over-the-counter" (OTC) when calling for a deregulation of certain medicines, effectively this is what would happen if prescribing rules are changed.
Even well-established OTC preparations such as paracetamol, ibuprofen and codeine can cause unforeseen problems. In last week's British Medical Journal, doctors from a London general practice describe how, in the past three months, they had seen three patients addicted to Neurofen Plus, which contains the anti-inflammatory ibuprofen and the painkiller codeine.
Because it is toxic to the gastrointestinal system and can cause stomach bleeding, ibuprofen and aspirin are not recommended in people with a history of peptic ulcer. And both aspirin and ibuprofen are known to provoke attacks in patients with asthma.
Apart from the risk of physical and psychological dependence, codeine causes side effects such as nausea, drowsiness and confusion.
So when pharmacists say they want to dispense aspirin 75mg without prescription for the prevention of heart disease, such a move would not be risk free. In the absence of the person's clinical records, how can a pharmacist be sure that the person did not have an acute peptic ulcer 20 years previously?
When the IPU says it wants its members to be able to hand out statins over the counter for "the prevention of heart disease", do they mean primary or secondary prevention? While there is strong evidence for the value of statins in stabilising pre-existing heart disease, who is going to monitor the patient for drug side effects such as muscle and liver inflammation? Only a blood test can establish whether a statin is causing liver toxicity.
In this context it is interesting to note the recent findings of the Oireachtas Joint Committee on Health and Children when it examined the issue of prescribing. "The pill for every ill culture is leading to excessive use of pharmaceuticals with attendant adverse drug reactions," it said.
It also noted that more than one-third of hospital patients were given the wrong medicines and that one in four outpatients in a Dublin teaching hospital were the victims of prescription error.
If the error rate in the hospital environment, where pharmacists are active team members, is this high, one can only imagine the potential for major problems in the community if medicines were to be significantly deregulated.
There is no doubt that pharmacists are experts in medicines but that does not make them experienced prescribers. What would make more sense would be a structured system whereby doctors and pharmacists in the community work more closely together to ensure safer prescribing and dispensing.
In the words of the Joint Committee on Health and Children, "the practice of medication reviews, with pharmacists as central, should be formalised".
•In last week's column it was stated that thiamine was vitamin B12. In fact, thiamine is vitamin B1.
Dr Houston is please to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries.