Drug safety watchdogs are preparing new guidance on prescribing, dispensing and administering anti-cancer and blood-thinning drugs after serious medication errors that have led to patients dying or being permanently harmed.
The drive to improve oral chemotherapy and cut risks with drugs used to prevent strokes and heart disease will be led by the government's National Patient Safety Agency and will be seen as vital in delivering the NHS priorities of improved cancer and cardiovascular services.
The moves follow warnings to cut fatal mistakes made through "wrong site injections", through anti-arthritis drugs, and through accidental use of potassium chloride - a chemical so powerful it is used for lethal injections in countries with the death penalty.
In the US, as many as 7,400 people may be dying each year from drug errors; the number in the UK is put nearer the low hundreds. The Department of Health will today publish a comprehensive report devoted to cutting such mistakes.
Anti-coagulants are one of the most common classes of drugs associated with fatal errors in primary care and are in the top 10 of compensation claims made against NHS hospital trusts.
Cancer drugs are particularly toxic and unnecessarily highdoses and long courses can be fatal. Mis-identifying drugs with similar names has led to doses being up to eight times too high.
Research has suggested that in the UK anything between one in 10,000 and up to one in 1,000 prescriptions lead to serious errors.
A pilot scheme preparing the way for anational reporting system on medical errors in England suggested that just under one in 200 reported errors had serious outcomes. The government insists this should not be taken as indicative for the NHS as a whole. In England alone about 660m prescriptions are written annually by GPs, averaging about 12 for every person. Another 200m are written in hospitals. The government has promised to cut errors by 40%.
Eighty-five people died between 1990 and 2000 following "adverse incidents" involving hospital drips and other transfusion devices, while mistakes involving the anti-arthritis drug methotrexate contributed towards 25 deaths and 26 cases of serious harm over a similar period.
Last night, Lord Warner, the health minister, said: "The great danger is you create a climate in which people feel really unsafe because you can produce really large numbers of medical errors when, in practice, the mistakes that are seriously harmful are relatively modest.
"But there is a balance to be drawn between worrying people and being open and transparent." Some mistakes were down to "sheer professional carelessness" but many were far more complex, involving systems of care, he said.
The drugs bill accounted for 12% of NHS budgets, he added.
Much hospital drugs administration still depends on hand-written prescriptions. The computer-delivered prescriptions from GP surgeries can involve dosage errors, however, and be keyed in wrongly by pharmacists (though pharmacists are also known to spot many of the doctors' errors).
Safety officials are already working with the pharmaceutical industry to reduce errors, producing better labelling, colour clues on packaging, and avoiding similar names for different drugs. And most hospital trusts are reportedly following safety rules on the use of potassium chloride, a chemical sometimes potentially fatally when used to dilute antibiotics.
David Cousins, the head of the agency's safe medicines practice, said: "Incident reports do not equal all incidents ... it's the tip of the iceberg."
