Preventing prescribing errors in general practice

Challenge

Prescription errors are preventable but often go undetected, resulting in harm, hospitalisations and even deaths. Serious errors affect 1 in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions, with repeated errors putting substantial pressure and cost on to the NHS.

What we did

To help mitigate these risks, we have been supporting the roll out of a pharmacist-led information technology intervention for reducing clinically important errors (PINCER).  It is one of seven programmes selected for national adoption and spread across the AHSN Network during 2018-20.

Using clinical audit tools, PINCER runs computerised searches on GP systems to identify potentially hazardous prescription safety indicators. Training is split into three sessions: providing pharmacists with a structured framework; quality improvement tools to undertake root cause analysis and agree an action plan with the practice; methods to improve systems and prevent new patients being at-risk of harm.

The PINCER analysis tool allows practices and CCGs to review progress following their quality improvement interventions, benchmark performance locally (and nationally) and generate time trend views.

Impact/outcomes

Since May 2019, we have worked with our local primary care providers to implement the tool, and as of March 2020:

• 153 pharmacists have been trained, across five boroughs of north central London (now merged as one CCG) and six out of seven boroughs in north east London
• 239 GP practices are uploading baseline data on to PINCER
• More than two million patient records have been searched
• 12,136 patients have been identified as at risk of medication errors

There has been an 18.5% reduction in the percentage of at-risk patients in our region  

“PINCER has allowed me to promote safer prescribing and monitoring within my Primary Care Network. I have been able to work closely with prescribing leads and GP partners to undertake root cause analysis to create safer and more robust monitoring procedures for the future, especially with regards to high-risk drug monitoring.”

Taariq, Clinical Pharmacist from Hackney Downs PCN

Next steps

In the wake of COVID-19, PRIMIS (part of the PINCER Team at the University of Nottingham) are converting training to create remote sessions (e-learning modules with short group webinars). This will create a sustainable platform for training to be delivered during COVID-19 recovery.

We are establishing communities of practice that will enable improved communication pathways across organisational boundaries and allow examples of good practice to be shared more readily.

Whilst our work resulted in a substantial reduction in the number of at-risk patients, there will need to be a refocus on monitoring these prescriptions as a result of patients staying away from GP practices during the COVID-19 period.

Overall I have found the PINCER IT team and their administrative, project co-ordinating staff to be helpful, passionate about the course and attentive.

Their support has enabled me to import data to many of my practice’s software system and identify high risk patients as well as provide me with the tools to implement this essential and safeguarding work.

It has and will hopefully, continue to ultimately improve the prescribing of our clinicians along side re-educating all those involved in the care of our patients, be it from administrative interventions right through to clinical decision-making level.

Clinical Pharmacist, Clissold Park PCN