Following a recent High Court judgment in relation to an ERCP complicated by pancreatitis, we wish to draw attention to some important principles for safe practice that are applicable to all endoscopists and endoscopy units. The case serves as a reminder of the importance of careful documentation around prescribing and consent and that these are primarily the responsibility of the endoscopist carrying out the procedure.

It is important to note that the following are general comments and should be reviewed in the context of local prescribing practice within the endoscopy units in which you work.

Key learning points

• Prescribe prophylactic medications appropriately: Where guideline-recommended prophylactic medication is indicated, such as diclofenac during ERCP, it is important to ensure that it is prescribed in advance and in accordance with local policy and legal requirements related to prescriptions. We do not recommend relying on routine administration or verbal instructions alone.
• Document drug administration clearly: Contemporaneous records should confirm the dose, route and timing of all medications administered during endoscopy procedures. Accurate clinical records are an essential part of patient care, supporting communication, continuity of care and medico-legal defensibility. If you do not work in a unit frequently, it is important to familiarise yourself with these processes within that unit before commencing work.
• Ensure consent is complete: Discuss and document all material aspects of the procedure and ensure consent forms are fully completed prior to the procedure commencing. Information and discussion about administration of medications under sedation is an important element of consent, particularly where the route of administration is rectal, and should be clearly documented pre-procedure.

Take-home message

Accurate and timely documentation, robust prescribing practices and a thorough consent process, which can all be clearly evidenced, are integral components of safe clinical care.