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National Patient Safety Agency

New guidance following laxative errors in NHS

19 February 2009


Today (19 February) healthcare organisations are being urged to review their current practice for the administration and use of certain types of prescribed laxatives given to patients prior to bowel surgery or examination.


The guidance is from the National Patient Safety Agency (NPSA) and has been issued to all NHS and independent healthcare organisations in England and Wales.


It comes after the NPSA received reports of 218 patient safety incidents and one death, between 27 November 2003 and 6 January 2009 involving oral bowel cleansing solutions. Of the 218 patient safety incidents over 90% resulted in low or no harm, with less than 10% causing moderate or severe harm.


Examples of incidents reported to the NPSA include:


  • A patient being inappropriately prescribed a bowel cleansing solution despite having a known bowel condition (ileostomy).
  • A patient being under-prescribed a laxative drug prior to a colonoscopy, resulting in inadequate bowel preparation and the patient’s surgery appointment having to be rebooked.
  • A patient not being supplied with clear instructions on how to take their prescribed bowel cleansing drug at home, resulting in dehydration.
  • A patient, who had received bowel preparation in hospital, being given insufficient fluids by staff, despite having major bowel surgery planned.


Linda Matthew, Senior Pharmacist at the NPSA said:


“The NPSA is advising all healthcare professionals to review their current practice to ensure that there is clarity over staff responsibilities in relation to the use of these bowel cleansing solutions. Of particular importance is the provision of information and explanation to patients about their use.


“Although over 90% of the incidents reported to us resulted in low or no harm, elderly patients and children are potentially at greater risk than adults if these medicines are not used correctly.


“Our guidance therefore applies to all healthcare settings where bowel cleansing solutions are prescribed or administered. We hope that these recommendations will improve the safety of these medicines and help to prevent avoidable harm to patients.”


View the Rapid Response Report on Reducing risk of harm from oral bowel cleansing solutions




Notes for editors:


  1. Media enquiries to Paul Cooney or Amelia Lyons in the NPSA Press Office on 020 7927 9351 / paul.cooney@npsa.nhs.uk or 020 7927 9580 / amelia.lyons@npsa.nhs.uk.
  2. Bowel cleansing solutions are prescribed laxatives given to patients prior to investigative or surgical procedures of the bowel. These medicines are frequently used in the NHS and pose no risk to patients if administered correctly.
  3. The bowel cleansing solutions highlighted in the NPSA’s Rapid Response Report are Picolax®, Citrafleet®, Fleet Phospho-Soda®, Klean Prep® and Moviprep®.
  4. Of the 218 patient safety incidents reported to the NPSA between 27 November 2003 and 6 January 2009, 93% caused low or no harm, and 6% caused moderate or severe harm.
  5. The MHRA has also received 11 fatal outcome reports and 44 reports between 1963 and 2005 indicating electrolyte imbalance/dehydration due to inadequate intake or use of oral bowel cleansing solutions where there is a contraindication. For more information view the Rapid Response Report.
  6. Rapid Response Reports are page-long notices which are based on evidence of harm to patients and identify clear actions for healthcare staff to reduce risks of recurrence. Since June 2007, 16 have been issued to NHS organisations in England and Wales.
  7. The National Patient Safety Agency is an Arm’s Length Body of the Department of Health. It encompasses three divisions; the National Research Ethics Service, the National Reporting and Learning Service and the National Clinical Assessment Service. Each has its own sphere of expertise to improve patient outcomes. The NPSA’s vision is to lead and contribute to improved, safe patient care by informing, supporting and influencing healthcare individuals and organisations.