Case report

A patient with hypertension was prescribed NSAIDs for possible gout. This resulted in improvement in his symptoms, and the NSAIDs were put on a repeat prescription, which continued for four years. During this time, he remained on anti-hypertensives and his blood pressure was well controlled, but his renal function was not checked.

When the patient's renal function was ultimately checked, his serum creatinine was 147µmol/L. A letter was sent inviting the patient to make an appointment for review, but no appointment was made and repeat prescriptions continued to be issued for both the NSAIDs and the anti-hypertensives.

Two years later, renal function was measured again and the serum creatinine had risen to 180µmol/L, and the calculated GFR was 36ml/min. Renal function was rechecked three months later and was unchanged. The patient remained on NSAIDs and the renal function was not repeated for another three years, by which time the patient had a GFR of below 20ml/min. At this point, the NSAIDs were stopped and a referral made to the nephrology clinic, but unfortunately renal function continued to decline and the patient required renal replacement therapy.

A Letter of Claim was received, alleging that there was a failure to monitor renal function despite long term prescriptions of NSAIDS to a hypertensive patient, and that once renal impairment was demonstrated there was a failure to stop the NSAIDS, and a failure to measure renal function regularly. It was alleged that had this occurred, end stage renal failure would have been avoided.

The MDU instructed independent GP and nephrology experts. The GP expert advised that renal function should have been measured more frequently, and once renal impairment was diagnosed, serious consideration given to stopping the NSAIDs and prescribing alternative analgesics.

The nephrology expert advised that the long-term prescription of NSAIDs made a significant contribution to the claimant's renal impairment and end-stage renal failure. In the light of this expert advice, and with the agreement of the MDU GP involved, the claim was therefore settled.

Prescription errors

Prescription error ad 1

Dr Claire Wratten

Prescription errors