An estimated 237 million medication errors occur annually in the UK, leading to more than 180,000 excess NHS bed days and playing a role in thousands of preventable deaths.

It’s time to tackle this silent killer, writes Dr Nicholas Appelbaum.

A hidden secret

Medicine – and more specifically, prescribing – has a hidden secret.  It’s rarely talked about, but is contributing to thousands of unnecessary deaths every year.

In the UK, an estimated 237 million medication errors occur annually, leading to more than 180,000 excess NHS bed days and playing a role in an estimated 1,700-22,300 preventable deaths. These errors are the leading cause of avoidable harm in healthcare and remain stubbornly persistent despite ongoing initiatives to reduce them. 

Prescribing errors make up a substantial portion of these medication errors and include mistakes such as incorrect dosages, selecting the wrong medication, or providing improper administration instructions. While some errors are caught immediately, others go unnoticed until harm has occurred.

The technology fallacy

If you’re not a clinician, you might assume that healthcare technology has evolved to handle these issues— after all, it’s 2024. But while technology has transformed most aspects of our daily lives, it has done little to alleviate the stress and responsibility clinicians face in ensuring prescription accuracy. This burden falls almost entirely on the clinician, with minimal support from existing systems.

Contrary to popular belief, electronic prescribing systems (EPSs) rarely calculate precise dosages based on a patient’s individual characteristics and conditions. Instead, clinicians often rely on printed resources (or, at best, app-based versions) to look up dosages, followed by mental arithmetic, paper calculations, or the use of unregulated online tools.

After determining the dose, clinicians then manually enter the drug, dosage, frequency and duration of therapy into the EPS. 

These systems, while configured to include smarter options like “order sentences” and “care sets,” still leave room for error, with dropdown menus often offering a confusing array of choices. EPSs may also include features like drug interaction alerts and basic dose range checks, but can create alert fatigue, a phenomenon where clinicians start to bypass alerts due to sheer volume. In some settings, this noise has led to features being scaled back or disabled altogether – a poor solution indeed.

Put simply, clinicians can use digital tools like CityMapper to navigate their commute and even pre-order their morning coffee, but find themselves relying on cumbersome, error-prone workflows for the most consequential decisions of the day.

The process is mentally taxing, and with every manual prescribing click—of which there are billions each year in the NHS—the potential for error is ever-present. As a clinician, I remember the anxiety that accompanied prescribing, especially for children, where mistakes can have grave consequences. 

Only recently, a child was given ten times the intended dose of an anticoagulant multiple times in three days, resulting in a brain bleed. Similarly, a nurse recently told me about one of their experiences: a near miss where a dose was mistakenly prescribed in grams instead of milligrams, resulting in a 1,000-fold error. Thankfully, the mistake was caught, but it could have had serious consequences.

These kinds of errors, and sometimes worse, happen daily across the NHS. 

Killing the killer

As we consider the future of NHS reforms promised by the Government, especially in light of Lord Darzi’s recent report, it is clear that getting the basics right should be the NHS’s top priority. Achieving any future vision will require foundational tech investments to support meaningful progress.

This must include prioritising enablers of innovation, enforcing open standards for interoperability, and actively supporting tools that make clinicians’ daily tasks simpler and safer. For prescribing, this means leveraging computing power and data to handle the complex, repetitive calculations clinicians face daily. It means digitally integrating the British National Formulary (BNF) directly into EPSs, eliminating the need for time-consuming manual lookups and calculations. It means using technology purposefully designed with clinicians and frontline staff in mind, where systems meet the expectations of 21st-century medicine by easing their workload, not adding to it.

This is not an unreasonable expectation. We committed to using computers to support the safe administration of medicines; now we must ensure they deliver on that promise. To make real strides in patient safety and personalised care, the NHS must move beyond rudimentary systems and fully utilise clinically informed, modern solutions to transform prescribing workflows.

The silent threat of prescribing errors has profound implications for both patient safety and clinician well-being. As we move further into the digital health era, it’s crucial to leverage technology not merely to digitise, but to enhance processes. 

I’ve seen firsthand how the right innovations can make prescribing significantly safer, reducing errors by approximately three-quarters. These advancements have the potential to save lives and ease the burden on dedicated clinicians.

We must act decisively to embrace these innovations, ensuring that technology supports healthcare rather than complicates it. The time to turn the tide on prescribing errors is now.

About the author

Nicholas Appelbaum is a medication safety expert with roots in frontline surgery, and driven by the urgent need to tackle life-threatening drug errors. After moving from South Africa to the UK to complete a PhD at Imperial College London, he partnered with Lord Ara Darzi, reshaping how clinical decisions are made under pressure. A Fellow of the Resuscitation Council (UK) and a Member of the Royal College of Surgeons, he’s built a career pushing the boundaries of patient safety.

As Clinical Lead at the Helix Centre, and with NIHR i4i funding, Nicholas spearheaded the creation of Dosium, delivering a cutting-edge decision support tool to empower clinicians in paediatric emergency medicine to prescribe more safely. His vision led to a collaboration with the Royal Pharmaceutical Society, putting the BNF at the heart of UK drug safety software.

Today, he continues to shape the future of healthcare as CEO and Co-Founder of Dosium, and as an Honorary Research Fellow at Imperial College London’s Institute of Global Health Innovation and Patient Safety Research Centre.