According to figures from NHS England nearly 6,000 people were harmed and 29 died as a result of NHS prescription errors in 2021. 

 

The NHS said almost one in six trusts still did not have a fully funded plan to introduce electronic prescribing, meaning they are still run at least partially using paper notes. 

 

5,349 prescription-related incidents were recorded as causing a low level of harm, which means they required extra observation or minor treatment. A further 520 incidents caused a moderate degree of harm, which can lead to further treatment, potential surgical intervention, cancelling of treatment, or transfer to another area. 

49 incidents resulted in severe harm, while 29 incidents were documented as having caused patient fatalities. 

 

NHS England said that while the NRLS was intended to record the actual degree of harm suffered by the patient, the large number of organisations reporting to the system means that cases were not always coded accurately. 

The NHS is undergoing a transition to a new system for recording patient safety incidents.  

 

An NHS spokesperson said: “Patient safety is paramount, and while they are rare in the context of the millions of patients who receive hospital care every year, it is vital any prescription errors are swiftly reported and action taken to prevent future errors." 

“As part of this action, over the last three years the NHS has invested £75m in electronic prescribing systems, which can reduce prescribing errors by almost a third, and more than five out of six trusts now have a fully funded plan to introduce electronic prescribing.” 

 

In one incident a patient was seen in an anticoagulant clinic. She informed them she was pregnant, meaning that her anti-blood clot medicine warfarin was stopped as it is deemed unsafe in pregnancy. Due to a series of miscommunications the patient was instead prescribed twice as much dalteparin as she should have been. She later passed away from a brain bleed. 

The incident was only discovered ten months later, when the coroner requested the doctor's report. 

The chief executive of Action against Medical Accidents, Peter Walsh said "These are very disappointing statistics and behind every one there is a story of personal suffering or tragedy. What is particularly frustrating is that prescription errors are probably easier to avoid than many things that go wrong in healthcare." 

“The fact that almost one in six trusts don’t have a funded plan to reduce these errors is quite shocking. Even with those that do, having a plan is not enough." 

“We are particularly concerned about vulnerable people such as elderly or disabled people in care homes, who may be more at risk because they may be less able to check for themselves and because they tend to get a less personalised service than the average patient.”