Preventing prescribing errors with PINCER

What is PINCER?

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, 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.

The 2012 Lancet paper showed that a pharmacist led information technology intervention for reducing clinically important errors (PINCER), substantially reduced the frequency of a range of clinically important prescription and medication monitoring errors. This was scaled up by the Health Foundation.

In 2017, the World Health Organisation (WHO) launched a Global Patient Safety Challenge: Medication without Harm with the aim of reducing the level of severe, avoidable harm related to medicines by 50% over the next 5 years, globally.

In order to support this Global Patient Safety Challenge, UCLPartners have been commissioned by NHS England to implement a pharmacist-led Information technology intervention for reducing clinically important errors (PINCER) to CCGs and GP practice pharmacists.

How is PINCER being adopted?

PINCER helps tackle these issues, by training GP practice pharmacists to deploy PINCER searches on GP computer systems, alongside Quality Improvement methodology, including root cause analysis, to identify why mistakes happened. The pharmacists then agree and implement a practice action plan.

It is one of seven programmes selected for national adoption and spread across the AHSN Network during 2018-20. It has now been spread to other parts of the country and is currently having further detailed evaluation of the implementation. It is anticipated that use of PINCER will result in fewer medication-related hospital admissions and cost savings to the NHS.

How to get involved with PINCER?

UCLPartners will be offering support to PRIMIS with the national rollout of PINCER until March 2021. If you are a pharmacist or pharmacy technician working in a GP practice and would like to participate in PINCER please follow the steps below:

Step 1

Email the following information for each practice you want to use PINCER in to mairead.mcerlean@uclpartners.com:

• Practice name
• Practice code
• Clinical system used in practice
• IG lead name
• IG lead email address
• Pharmacist/ pharmacy technician name
• Pharmacist/ pharmacy technician email address
• CCG area your practices are based
• Who you are employed by e.g. PCN contract/ CCG/ practice

Step 2

Once we have these details PRIMIS will send you and the IG lead an email containing links to register and sign a Data Protection Agreement (DPA).

Step 3

PINCER training is comprised of three Action Learning Sets (ALS):

• ALS1 is self directed e-learning (available on the PRIMIS hub PINCER RESOURCE CENTRE)
• ALS2 is an interactive online webinar (requires eventbrite registration to attend)
• ALS3 is an interactive online webinar (requires eventbrite registration to attend

Before attending ALS2 and ALS3 you are required to complete some tasks summarised in the table below.
ALL of these materials are available on the PRIMIS hub PINCER RESOURCE CENTRE.

BEFORE attending ALS2:

BEFORE attending ALS3:

– Complete ALS1 self-directed e-learning module. – Run the PINCER indicators in at least one practice and upload to Chart Online. – Print/ download your practice summary pdf report from Chart Online. – Undertake a brief overview of some of the indicators to identify possible reasons for patients being at risk. (You are not expected to started work on solutions or to go into much depth as this is part of the ALS2 workshop). – Read the ALS2 prior reading.

– Online ALS2 e-learning form. – Watch the CHART online video tutorial and access your data within CHART Online. – Complete Root Cause Analysis (RCA). – Deliver a feedback session with one of your practices. – Create an action plan with practice input. – Complete reflective diary of your learning/ experience. – Read the ALS3 prior reading.

Please register via the Eventbrite links below for ONE of the ALS2 sessions and ONE of the ALS3 sessions.
Note: you must attend ALS2 before attending ALS3. It is recommended to have a minimum of 6 weeks between ALS2 and ALS3 in order to complete the tasks in between these sessions.

ALS2 webinar dates	ALS3 webinar dates
ALS2: Wed 3rd Mar 2021 at 14:30-16:30	ALS3: Wed 10th Mar 2021 at 15:00-17:00       ALS3: Tues 16th Mar 2021 at 10:00-12:00     ALS3: Wed 21st Apr 2021 at 14:30-16:30

Celebrating success

We have exceeded our target for FY 2019/20 for PINCER, with 239 practices across UCLPartners uploading baseline data. We’ve trained over 153 Pharmacists across 12 CCGs. On 29 April we hosted a webinar to celebrate this success, consider what has worked well, where there is room for improvement and next steps for PINCER. Watch the full webinar below.

Download the full slide set here.

Contact us

If you are a CCG, GP practice or practice pharmacist interested in using PINCER, please contact Mairead.McErlean@uclpartners.com

Helpful links

• British Journal of General Practice 2013 – The prevalence and nature of prescribing and monitoring errors in English general practice: a retrospective case note review
• British Journal of Clinical Pharmacology 2006 – Which drugs cause preventable admissions to hospital? A systematic review
• BMJ 2004 – Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients
• University of Nottingham; Implementation of the PINCER tool – Lessons for effective roll-out; Gill Gookey
• The Lancet 2012 – A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis
• University of Nottingham – Primis and PINCER
• PINCER Myth Buster
• The AHSN Network – PINCER
• The Pharmaceutical Journal 2019 – The GP pharmacists leading a life-saving medicines safety project
• DOHSC 2018 – The Report of the Short Life Working Group on reducing medication-related harm
• Wessex AHSN PINCER and Primis information and help
• PLOS Medicine 2020 – Evaluation of a pharmacist-led actionable audit and feedback intervention for improving medication safety in UK primary care: An interrupted time series analysis
• Health Innovation Manchester – SMASH Intervention