Prescription errors: keeping millions safer
Some 340 million GP consultations are held in England every year and one billion medications dispensed. Even with the most rigorous practices and highly trained practitioners there is clear potential for errors in any system that’s so busy and dealing with the complex challenge of prescribing effectively and safely for individual needs.
In fact, one in 25 hospital admissions in England are linked to prescription errors, a preventable cost to the NHS of more than £650m a year.
Now, thanks to an online tool created at the University of Nottingham, GPs in every surgery in England will be better equipped to reduce the human and societal cost of prescription errors. Known as PINCER, this pharmacist-led IT-based intervention tool – created to reduce clinically important medication errors – was developed by pharmacists and primary care researchers and colleagues in PRIMIS; a business unit within the School of Medicine with expertise in extracting knowledge and value from primary care data.
PINCER searches GP computer systems to identify patients who are potentially at risk from hazardous prescribing using a set of safety indicators. The doctors are alerted and work with pharmacists to head off this potential prescription error. GPs are familiar with other ‘pop-up’ alerts and sometimes inclined to ignore them – what makes PINCER more effective is bringing together doctors and practice-dedicated pharmacists to support a coordinated action plan for each patient.
Professor Tony Avery, a primary care researcher and practising GP, immediately recognised the strengths of PINCER but he is immensely gratified that his peers on the NHS frontline have embraced the system.
“We’ve got 93% uptake in the East Midlands, which is just phenomenal,” said Professor Avery. “Now we have support for a national roll-out of the PINCER intervention and we are expecting close to 100% coverage across England over the next two to three years.”
Initially trialled in the East Midlands, PINCER was rolled out to 370 general practices between 2015 and 2017, with 21,000 instances of hazardous prescribing identified, and more than 10,500 patients receiving safer care as direct benefit of the PINCER intervention.
In addition to the East Midlands rollout, since 2013 the PINCER tool has been downloaded and used by over 2,400 practices (almost a third of provision in England) across 199 Clinical Commissioning Groups.
"The national adoption of PINCER has the potential to benefit millions of patients across England."
NICE, the National Institute for Health Care Excellence, has recommended the adoption of PINCER and this will drive even wider take-up by encouraging all GPs to adopt the online tool and approach.
Medication errors have also been identified as a global challenge by the World Health Organisation and in response to this, the then Health Secretary Jeremy Hunt set up a working group. One of its recommendations was a national roll-out of PINCER as a “proven intervention in primary care” and this is being taking forward by the National Academic Health Science Network.
The team’s evaluation of the impact of PINCER on prescribing safety was published in The Lancetand the evidence for the benefits of pharmacists in primary care has helped to inform a £143m investment by NHS England, which places pharmacists inside general practices.
Dr Matthew Boyd said, “PINCER’s remarkable success complements this cultural shift. We are no longer being ‘parachuted in’ to surgeries. By working so closely with GPs, pharmacists connect better with patients. They are brought back for a review, the perceived quality of care goes up and this raises the bar for what general practices offer to patients.”
A more detailed evaluation of the East Midlands roll-out and therefore PINCER’s potential national impact will be made as part of a £2.4m National Institute for Health Research grant, which Dr Sarah Rodgers, Principal Research Fellow, was awarded alongside Professor Avery.
Evidence indicates that PINCER would prevent 1,375 cases of serious harm from prescription errors a year, saving the NHS £3m, and Dr Rodgers said: “The national adoption of PINCER has the potential to benefit millions of patients across England.”
Dr Rodgers and Professor Avery were invited to the Palace of Westminster in July 2018 to pick up PINCER’S NHS Midlands and East Excellence in Primary Care Award as part of the NHS70 Parliamentary Awards. Nottingham MP Lilian Greenwood said: “The PINCER team have developed ways of making improvements to the safety of prescribing medicines in primary care and have made a huge impact both locally and nationally.”
Tony Avery is a Professor of Primary Health Care, School of Medicine, Dean of the School of Medicine, and part-time GP.
Dr Matthew Boyd is an Associate Professor in Patient Safety and Pharmacy Practice, School of Pharmacy. Matthew's current research includes an evaluation on behalf of NHS England of the impact of placing pharmacists in general practices.
Dr Sarah Rodgers is a Principal Research Fellow with the School of Medicine. Her main research interest is prescribing in primary care and she has also worked as a researcher in industry and the NHS.