Preventing prescribing errors with PINCER

Taher Esfandiari is one of our Digital Pioneer Fellows. Taher is a Clinical Commissioning Pharmacist, part of the Medicines Optimisation and Long Term Conditions team at NHS Lambeth CCG.

Have you noticed your GP practice is no longer prescribing medicines you may have used for some time? Or are they adding a medicine to your prescription list and asking you to attend the practice for blood tests?

This, in part, is due to the patient safety agenda making its way through various parts of the NHS. In recent years there have been reported instances of patients experiencing unintentional and often preventable harm due to prescribing errors. Serious errors affect approximately 1 in 550 prescribed items, while hazardous prescribing contributes to around 1 in 25 hospital admissions. These errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even death.

2019 marks the start of a national quality improvement (QI) programme to proactively reduce the potential incidence of preventable harm by introducing a pharmacist-led information technology intervention for the reduction of clinically important errors in primary care, otherwise known as PINCER. It is one of the Medicines Optimisation projects selected for national adoption and spread across the Academic Health Science Network in 2018-2020.

Whilst the role of a practice pharmacist has existed for decades, 2015 saw an influx of pharmacists into general practice. This helped to support some of the workforce challenges facing primary care.

Across the borough of Lambeth, in addition to their current responsibilities, practice pharmacists are today being utilised to ensure patients are kept safe by delivering the PINCER intervention. These pharmacists have been trained to identify patients at risk of:

• Gastro-intestinal bleeds – resulting from the current use of either warfarin, clopidogrel, direct oral anticoagulants or non-steroidal anti-inflammatory drugs
• Monitoring errors – resulting from the current use of an angiotensin-converting enzyme inhibitors, loop diuretics, lithium or methotrexate
• Other errors – involving medicines such as beta blockers

The records of the patients identified are analysed to determine how these patients came to be at risk of harm by conducting a root-cause analysis (RCA). The findings from the RCA are discussed with practice colleagues and an action plan is agreed to review these patients and to address the causative agent(s) which is putting the patient at risk of harm. Some examples of patients identified include; patients over the age of 65 years who are prescribed long term ibuprofen who are not co-prescribed a proton-pump inhibitor to prevent gastric bleeds.

This process can be repeated as often as required, however, by putting systems in place to abate the points highlighted from the RCA, it is hoped that these would prevent future patients from falling into these at-risk groups, therefore reducing the need for a frequent intervention.

With time, we will see:

• A reduction in the number of patients at risk of harm.
• A reduction in the number of hospital admissions related to patients’ prescribed medication.
• The profile of practice pharmacists raised among their multidisciplinary team and patients.
• Even better use of our finite resources.

This marks the infancy of QI in General Practice which I believe will help shape Primary Care Networks and deliver better outcomes for patients for years to come.

Learn more about our Digital Pioneer Fellowship here.