By Ken Thomas, medical negligence specialist at Harding Evans Solicitors

Errors made by pharmacists form a significant element of my work. These are errors made by hospital pharmacists or by high street chemists, be they independent businesses or part of a national chain. Pharmacists are experts in medicines – there are 2000 of them working in Wales. The Royal Pharmaceutical Society of Great Britain is the regulatory and professional body for pharmacists. All pharmacists in this country must be registered with the Society.

Across the country, many patients suffer every year as a result of being dispensed a medication which differs from that set out on the prescription they presented. Many more of these instances no doubt go unreported.

In my experience, cases fall into three broad categories. Firstly, those where an under dose of a drug is dispensed. For instance, the prescription from the doctor may refer to 800mg tablets of the drug. The pharmacy may dispense 400mg tablets instead. Secondly, overdose scenarios – that is, where the pharmacy wrongly dispenses higher strength medication than that prescribed by the doctor. Finally, those situations where the wrong drug completely is dispensed. Where repeat prescriptions are provided, the mistakes can be repeated likewise.

So why do such errors occur? The fact many drugs have similar names can be a problem, not to mention similar packaging. There might have been a failure to read the prescription properly or clarify it with the doctor if it is unclear. However there should be a checking system as a safeguard. In the cases I have seen, that has failed to prevent the error. How many of us check our dispensed drugs before taking them? Probably very few.

A Department of Health report in early 2004 considered ways medication errors could be reduced. For example, labels should be read at least three times – on selection, labelling and issue. Drug name, strength and formulation should be checked. The Report’s authors found that certain drugs are more often involved in dispensing mistakes than others, aspirin being one of them.

Within the hospital setting, there is obviously scope for patient misidentification. That can mean Patient A getting the drug intended for Patient B. The Audit Commission came up with some frightening statistics two years ago suggesting a 5-fold increase in hospital death from drug prescription errors on the previous year. A briefing paper produced for Assembly Members in 2003 suggested that in an average District General Hospital there will be approximately 350 medication errors per day. Further, that based on statistics, might be seriously harmed or killed in the average Welsh District General Hospital every 3 days.

Of course, medication is also dispensed in nursing and care homes. Earlier this year, a nurse from South Wales was struck off the professional register after giving the wrong drug to a care home resident and failing to act appropriately thereafter.

It will be obvious that such cases are understandably very difficult indeed to defend. Every client I have represented in such circumstances has received compensation. Most of these cases are therefore appropriate for “No Win, No Fee” Agreements and in the grand scheme of things, tend to settle quickly. Damages range from a few hundred to several thousand pounds, the claims being handled by the National Pharmaceutical Association on behalf of the pharmacy in question.

Those at particular risk can be the elderly and the very young. Personally, I have acted on claims for toddlers through to pensioners. There is another dimension to this from a Welsh perspective. It is widely reported that Wales remains one of the sick men of Europe. We still feature prominently in ill health league tables. The last census showed a significantly higher incidence of illness in Wales than in England. Arguably, more illness means more medication and potentially greater scope for dispensing errors.

The effects of the dispensing error can be fairly minor, but on the other hand, can be severe in some instances. For instance, an epilepsy sufferer can have a fit if dispensed an under dose of their medication in error. In several of the cases where I have acted for Welsh claimants, the medication in question was being used to control a long term, serious condition. Where the control of that condition is disrupted by a dispensing error, the experience for the patient can be really quite frightening. My clients have told me that they concluded, when they symptoms flared up or worsened, that their condition was deteriorating, not thinking for one minute that the problems were in fact due to a disruption in the medication regime.

Of course, it must be said that the experience can also be upsetting for the pharmacist or staff involved. The health authority can become involved and launch its own investigation.

Mistakes of this nature can bring further pressure to bear on an over-stretched NHS if they lead to the patient needing further treatment to deal with any effects of the medication wrongly dispensed, perhaps including hospitalisation. It has been estimated that adverse reactions to medicines and medication errors currently cost the NHS perhaps half a billion pounds a year. Of course, where the error is made in a high street or superstore pharmacy, it is the insurer, not the NHS who pays out the compensation. These payouts do not always feature in the NHS negligence totals.

Modern developments in pharmacy dispensing might in themselves create new problems. For instance, more and more patients, especially the elderly, now have their medication delivered by their local pharmacy. That potentially increases the scope for human error. In particular, there is of course scope for the delivery man/woman to hand over the wrong medication on the doorstep. I am acting on one such case now. Another issue arises from increasing numbers of pharmacies in superstores. That is quite a different environment from many high street chemists. It begs the question whether in the midst of often very busy and hectic superstores, more dispensing mistakes may occur. Again, I have recently settled a case where a dispensing error was made by a pharmacist working inside a superstore.

New roles for pharmacists, such as supplementary prescribing may lead to greater exposure. To ease the burden on doctors (and minimise patient waits) pharmacists are being allowed to prescribe certain medicines themselves with agreed parameters. If pharmacies provide increasing over the counter advice, again that may widen the scope for (and number of) claims in their advice proves erroneous.

The Assembly is committed to introducing an increasing role for automation in drug distribution and dispensing. Advances in technology mean that robotic dispensing systems have now been installed in some Welsh hospital pharmacies. Patient safety may be improved if dispensing errors are reduced – so long as the technology works properly. In point of fact, computerisation can bring its own problems. In one of my cases, the initial dispensing error was perpetuated for some months by the fact the pharmacy in question could print off previous labels for later prescriptions from the computerised record.

There are now even online pharmacies. These offer delivery of certain prescription drugs to the home or workplace. The patient completes an information form and sends that off with the prescription and any fee. The drugs are then sent out in return by Recorded Delivery.

Suggestions of a compensation culture have perhaps proved misleading. Research suggests that the overwhelming majority of patients who suffer as a result of these or other medical mistakes do not complain or seek to bring claims. Arguably however, if the mistake is not followed up, the scope for it being repeated may remain the same.

Thankfully, the Government is aware of the problem and last year the NHS Plan for Pharmacy was published, setting out a proposed requirement for pharmacists to report adverse incidents. Only last month the Royal Pharmaceutical Society of Great Britain produced an up-to-date fact sheet providing guidance to pharmacists in dealing with dispensing errors.

Ultimately, given the vast number of people who require medication, such errors are not surprising. Millions of prescriptions are provided and presented to pharmacies every year in Wales – it is estimated that 100,000 people in Wales visit a family pharmacy for a health related matter every day. Put into perspective, the majority of drugs are correctly dispensed and no-one is really suggesting that today’s pharmacists are more careless than their predecessors. However, the fact remains that if mistakes occur, like all medicine related errors, lessons should be learnt.