Clear lines of communication between everyone in the practice are essential to minimise the chances of something like this happening...
A dentist received a lawyer’s letter alleging negligence in connection with the administration of prophylactic antibiotics. The patient attended the dentist’s surgery where a full assessment, including a medical history, was performed and the patient confirmed that she had a heart murmur. She was due to return for further treatment and the member prescribed an antibiotic to be taken one hour prior to the dental treatment.
The patient reported that she was allergic to penicillin and this was confirmed on the medical questionnaire. Consequently, a prescription was given for a 3g sachet of erythromycin as an oral suspension.
The following day, the patient went to the pharmacy to obtain her medication. The pharmacist realised that erythromycin was only available in 500mg/5ml and phoned the dental practice in an attempt to contact the dentist, who was unfortunately away from the premises. The pharmacist pointed out that, while erythromycin was only available in 500mg/5ml, amoxycillin was available in 3g sachets. The pharmacist requested permission over the telephone to change the prescription to amoxycillin, which a member of the dental team gave.
Unfortunately the pharmacist was unable to identify the member of staff to whom he spoke and subsequently it was not possible to confirm the identity of this person. When the patient came to collect the prescription, she was not informed that it had been changed to amoxycillin and assumed that her prescription did not contain penicillin.
Subsequently, the patient attended the practice to have the dental treatment carried out and informed the dental nurse that she had taken her antibiotic and that she was feeling unwell. Treatment was to be carried out under sedation and the anaesthetist, realising that the patient was allergic to penicillin and had taken amoxycillin, administered antihistamine. No treatment was carried out at that appointment and the patient was discharged home by the anaesthetist when he felt she was well enough and in no medical danger.
An avoidable injury
It appears that when the patient returned home, she became unwell, suffered a fall and sustained an injury to her right hand. The dentist admitted that there had been a lack of communication between the dental surgery and the pharmacy and that as a result, amoxycillin had been prescribed when it was clear that the patient was allergic to this antibiotic. It was conceded that the dentist had vicarious liability in respect of any actions or decisions taken by his members of staff and Dental Protection negotiated a settlement of this claim for a small amount.
Clear lines of communication between all members of the dental team are required to establish individual areas of responsibility. It is important that all dental team members are familiar with the scope of the clinical activity appropriate to their role, as defined by their national regulatory body (Dental Board or Dental Council).