WWYD if GP prescribed medication that your child should not have due to an allergy

[UncomfortableSilence]

Just want to see what others would do in this situation.

DD16 had a phone consult today for an update on how she's getting on with her Pill. She has horrendous periods and is under the hospital too. She hasn't been getting on great with it so the nurse suggested she change to a different brand, same ingredients.

DD read the information leaflet and it specifically says it must not be taken if you have a Soya/Peanut allergy. DD has a peanut allergy. I immediately rung the surgery but she wasn't available, I briefly explained and asked for her to call me. Instead she text DD and told her to throw away the pill and put her back on the one she was on before that she is having trouble with.

Obviously this could have had terrible consequences.

How would you deal with this as my DM has gone batshit that I was only going to put a complaint into the practice manager?

Did GP ask DD if she had any allergies?

What does your mum want you to do?

Tell DD to book another appointment to discuss alternative options?

If she can't take the pill she's got then she can stop taking it and until she's sorted with alternative contraception.

There's also literally no reason to put in a complaint...

Flag it with the practice, the gp probably will have done too, as its a near miss and a useful reminder.

User - No they didn't, it's on her records and she is prescribed EpiPens

Girlmom - It's not being used for contraception as explained in my post so that's not relevant, it's the fact they prescribed her medication that could cause an anaphylactic reaction.

Walkabout - Thank you this was what I had decided to do, the leaflet is so very long and could have been disastrous if she hadn't read it carefully. The onus must be on the GP in some way here surely. So want to alert them to what happened firstly and secondly to ensure DDs records are correct with her allergy clear for all to see when prescribing.

Honestly I don't see how it's the GPs fault, they simply cannot know what ingredients are in every single medication.

Since she has the allergy it is ultimately always your DDs responsibility to do two things:

1. Inform and remind every health practitioner about her allergy before they prescribe and query the medicine even if it's on her notes

1. Check every health leaflet for contraindications before using it. Which is what your DD wisely did and the surgery dealt with by telling her to immediately stop using it or not use it, and then putting her temporarily back on the medication she was on before, until she can get a new appointment for a different med. I assume this is likely to prevent her getting side effects from suddenly stopping hormonal medication.

I'm very critical of GPs as I have a health condition that is very badly treated in the NHS, but I see nothing to criticise here. Flag it by all means, but I really don't suggest you make a big fuss.

I would raise with practice manager myself, and then before taking further I would want to know what is expected of a good GP doing their job correctly. But I might take further if it fell below the standard expected by doctors generally.

This is why those with allergies or with children with allergies end up stressed - you can't drop your guard for a second! Glad you spotted it.

"Honestly I don't see how it's the GPs fault, they simply cannot know what ingredients are in every single medication." They should check where someone has a known and treated allergy on their records, I would expect.

My DSS has a peanut allergy and while he had mentioned it on his application he never discussed it really with his employer. He was served a staff meal cooked in peanut oil. He hadn’t taken his epipen with him but his manager had the foresight to rush him straight to hospital. He was treated in the car park and after a hospital stay made a full recovery. We never thought to blame his employer as at 18 DSS should have made his employer fully aware , carried his medication, and checked before he ate anything different as he would have done in a restaurant. Your daughter’s vigilance averted a problem but she should have reminded the GP about her allergy if not asked.

Blimey. What pull has to be avoided with a peanut allergy? I would never have thought to check that.

In this case it's more likely to be a pharmacist error.
They have so much more training than GP's for interactions between drugs and the human body or other drugs.
If it was your regular pharmacy then they will have all of your dd's previous medication pointing to an allergy which should have been checked with every other medicine dispensed
Also depending on the system, any issues with certain drugs will flag up an error message before the item can be dispensed, bit like the cookie message on every website!
By all means speak to the GP but also the pharmacy too.

@UncomfortableSilence

User - No they didn't, it's on her records and she is prescribed EpiPens

Girlmom - It's not being used for contraception as explained in my post so that's not relevant, it's the fact they prescribed her medication that could cause an anaphylactic reaction.

Walkabout - Thank you this was what I had decided to do, the leaflet is so very long and could have been disastrous if she hadn't read it carefully. The onus must be on the GP in some way here surely. So want to alert them to what happened firstly and secondly to ensure DDs records are correct with her allergy clear for all to see when prescribing.

It doesn't matter why it's being used. Other forms on contraception can help with a variety of issues that the pill helps with.

It's the responsibility of the patient to make sure the medicine is appropriate. Your daughter was smart. You're dramatic.

Did has an allergy and every time she is prescribed a new medication or gets something over the counter she asks “does it contain x”. She also reads the leaflet herself.

The GP wouldn’t know that this pill says that. I don’t think they flag up like that. Maybe a campaign is needed for better allergy labelling on medication similar to food but I think thjs is a nationwide systems error not an individual GP.

I have a similar allergy. You can never rely on other people to check this. I feel it is my responsibility to remind everyone, including my GP, and to read ingredients carefully. You trained your dd well. She did what she was supposed to do and the problem ingredient was spotted. This is why ingredients are listed. Whilst you can expect 'peanut allergy' to be written on all of her records, you surely do not expect medical staff to know the ingredients of every medicine. I would flag it up as there may be something they could do to make their systems more robust but god knows what your mum expects to happen.

I dont think you need to complain. Your dd did the right thing by reading the leaflet carefully. The GP is now aware that this particular drug contains peanut oil. Ideally this should flag on the system as contraindicated for your daughter but didnt.

I have a nut allergy and was recently prescribed HRT - when writing the prescription, the GP said the system flagged up a warning for the tablets because of soy as an ingredient. So she changed the scrip to patches.

So presumably a safeguard like this can be put in place? I don’t know how it works. While the previous posters are right that we allergic types should check everything, it is easy to make mistakes like this. You’re not being dramatic - you’re worried, rightly. Flagging this up to the surgery is the right thing to do.

I wouldn't remember what every drug contains but that's why our computer systems have interaction checkers which alert you to these interactions. Also people might not always think that a peanut or soya allergy affects medication.
I wouldn't make a complaint. I'd just bring it to the GPs attention as I would like to run it through the system again to see if the contraindications had come up and if not I would alert the pharmacy team. Obviously the local pharmacist should be told too.

At 16 for contraception it’s only appropriate the GP deals directly with the patient and not her mother by the way - that’s why they responded to your phone call by texting her - it will be a policy to to do this

I’ve just had a quick google and it looks as though this is something which applies to some, but not all, brands of a particular pill. As a GP, I’d be reliant on the computer system to warn me of that - I know about the drugs but not about the other stuff that goes into tablets. So I agree with others, definitely flag up with the GP practice as there’s clearly a risk here but I don’t think they’ve done anything way outside what I’d expect. Also well done to your DD for checking, just shows how important it is.

I would flag it with the GP practice so that they can look into whether anything can be done to prevent similar issues in future.

I know when I used to work on reception and we'd add new medications as instructed on hospital letters, it would sometimes come up with alerts about possible drug interactions with other medications that were already being prescribed. We'd then let the GP know and see if they were still happy to prescribe. It also graded these alerts as medium/high severity.

I don't recall ever seeing an alert pop up in relation to an allergy recorded on the patient's notes, but I imagine this would be a really useful functionality for the system to have.

If this isn't already built into the system, perhaps the GP surgery could raise some sort of incident report to those higher up the chain, to see if this kind of functionality could be added? Or if this functionality already exists, they could look at why no alert popped up when they prescribed your daughter's pill?

Either way, I think it would be good to raise it with them. They can then have a look into it and let you know whether there is anything they can do to improve things, and if not then at least you know that you'll have to carry on being extra vigilant whenever a new medication is prescribed in future.

@girlmom21

There's also literally no reason to put in a complaint...

They prescribed something which their own records showed the patient was allergic to. Of course that's valid reason for a complaint. Anaphylactic shock can be fatal.

It doesn't matter who's fault it is. What matters is that had this not been picked up, OPs daughter could have died.

The GP practice will want to learn from it and see what they can do (e.g. system flags) to make it safer in future. Hopefully the GP will have flagged it but making a complaint with that aim isn't a bad thing.

We don't want the only thing keeping a 16 year old safe to be their good sense. But we can't expect GPs to be perfect either. Blame is really unhelpful.

I think your daughter should have mentioned her allergy during the consultation.
A near miss and you should alert the practice manager. However it's a mutual responsibility between patient and doctor to highlight allergies

This worries me to death. It is impossible to know all the ingredients in all medication, and there is no good database of allergens in medication unless it is the active ingredient (aka the medication itself), so if you have an allergy, the only way to check is to open every leaflet of every medication and read through the non-active ingredient lists. I would not have thought to look for peanuts in any contraception and nothing would have flagged up on the computer system. As a GP this is very worrying, because there is absolutely not the time to just 'doublecheck' every medication's non active ingredient list.
I know of over the counter medication made with shellfish which has that written on the box for this reason (not nearly obvious enough, in my opinion), but it would be great if the database which warns me that a medication will react with another or that the patient has an allergy to, included all the non-active ingredients as well.