Medicines, overdose and severe allergic reaction

Contacts about medicines often sound administrative at first: a prescription query, missed dose, wrong medicine or supply delay. These can become urgent if the medicine is high risk or the patient is unwell.

Reception staff must not judge the clinical significance of a medicine problem. They should recognise language that suggests immediate risk and use the local escalation route so a clinician or pharmacist can take ownership.

Listen or look for

• Overdose or possible poisoning, including taking too much, accidental child ingestion or uncertain quantities.
• Wrong medicine or wrong dose taken, especially with new symptoms, high-risk medicines or vulnerable patients.
• High-risk medicine interruption: insulin, anticoagulants, epilepsy medicines, steroids, chemotherapy, transplant medicines or strong pain medicines.
• Severe allergic reaction: swelling of the lips, tongue or throat, breathing difficulty, collapse, wheeze or a widespread rash with the person feeling very unwell.
• Urgent supply problems where delay could cause harm, for example no insulin, no inhaler, no seizure medicine or missing end-of-life drugs.

Do not treat all medicine queries as admin

Some medicine issues can be managed through routine prescription processes. Others need urgent input from a pharmacist, clinician, NHS 111 or emergency services. Local protocols should help staff distinguish routine queries from wording that suggests immediate risk.

If a caller reports they have already taken the wrong medicine, taken too much, or developed swelling or breathing difficulty after a medicine, do not leave the request for routine processing.

Medicines note

A medicine query is urgent when the wording suggests overdose, wrong medicine, allergic reaction, high-risk interruption or the patient is becoming unwell.