Implementing the PINCER intervention in the East Midlands to reduce prescribing errors
Problem
Prescribing errors in general practice are an important and expensive preventable cause of safety incidents, illness, hospitalisations and deaths. A recent study in English general practices, identified prescribing errors in 5% of prescription items, with one in 550 items containing a severe (potentially life threatening) error. Given the prevalence and nature of prescribing errors (and the severity of harm associated with these), there is an urgent need to spread interventions known to correct these errors. A pharmacist-led information technology intervention for medication errors in general practice (‘PINCER’) has been shown in a randomised controlled trial to be effective in reducing rates of potential prescribing errors. This intervention involves searching GP clinical systems using computerised prescribing safety indicators to identify patients at risk from their prescriptions, and then acting to correct the problem with pharmacist support.
Approach
The aim of this study was to evaluate the large-scale rollout of PINCER across the East Midlands over an 18 month period using a stepped-wedge study design. A Quality Improvement Collaborative (QIC) approach was used to implement the intervention whereby an expert team, using structured activities, engaged clinicians and pharmacy teams to effect improvement in specific areas of practice. Support was provided in the form of education, feedback and opportunities for shared learning. Improvement was measured using anonymised routinely recorded data from general practices collected retrospectively, at three monthly time points. These data formed the basis of statistical process control (SPC) charts which were used to provide feedback at both Clinical Commissioning Group (CCG) and practice level. Contextual factors for implementation, the acceptability and feasibility of the intervention in a range of settings and what factors (whether at CCG or practice level) enhanced its effects were explored using qualitative methods.
Findings
Twelve CCGs implemented the PINCER intervention in 360 general practices between September 2015 and February 2017. A total of 2.9 million patient records were searched and 21,636 instances of potentially hazardous prescribing identified from 11 prescribing safety indicators. Data collection and analysis is ongoing; however early indications show improvement in CCGs and practices for specific prescribing safety indicators. Findings for each of the indicators will be presented at the conference, along with lessons learned about the implementation of PINCER across the East Midlands at ‘scale and pace’, including barriers and facilitators, timeliness, fidelity and transferability.
Consequences
PINCER has been widely implemented across East Midlands’ general practices with early indications of reductions in potential prescribing errors. Given that one in 25 hospital admissions relate to hazardous prescribing at an annual cost of around £650 million, the intervention should result in clinically important reductions in prescribing errors, anticipated reductions in medication-related hospital admissions and deaths, and net cost savings to the NHS.