About Mairead McErlean
Mairead is a pharmacist and has extensive clinical experience working in various NHS Trusts and the private sector across London. Currently, Mairead is working as part of North London Partners Medicines Efficiency Programme and is involved in driving improvement related to optimising medicines as part of the Sustainability and Transformation Programme (STP). She is also supporting UCLPartners Academic Health Science Network with the national rollout of PINCER, the project that she has been working on as part of her Digital Pioneer Fellowship.
Problem: Mairead wanted to reduce the number of prescribing errors in general practice to improve medicines safety.
Solution: PINCER (Pharmacist-led information technology intervention for medication errors) is a national quality improvement intervention supported by randomised clinical trial evidence demonstrating benefit in patient outcomes. It includes a search tool identifying at risk patients so that corrective action can be taken to reduce hazardous prescribing. The intervention also involves face-to-face consultation with GP practices and a multi-faceted training programme for pharmacists across organisational boundaries to deliver corrective actions to hazardous prescribing at scale. Using the comparative analysis database- CHART Online along with the PINCER search tool makes it possible for practices to view their results both in relation to other practices within their CCG and nationally and also see their improvements over time.
Scale: As part of NCL STP, the team’s sphere of influence would extend to five Clinical Commissioning Groups (CCGs) – Barnet, Camden, Enfield, Haringey and Islington:
• There are 231 GP practices in the region.
• They serve a total population of approximately 1.44 million residents.
• The estimated number of potential medication errors is 185,000 through extrapolation of the numbers identified from the large multi-centre trial (480,942 patients from 72 GP practices experiencing 63,337 events (13.5% medication error rate)).
Desired impact: Results published in the Lancet showed that PINCER is a clinically and cost-effective method for reducing a range of important and commonly made medication errors in primary care. There was a 44% reduction in proportion of patients with at least one medication monitoring error. Further evidence estimates that there is an average cost reduction of £2,679 per practice from avoided hospital admissions. For NCL, this could be approximately £600k cost avoidance.
Progress to date: Across the UCLPartners region, there are 6 out of 7 North East London (NEL) CCGs and 5 out of 5 North Central London (NCL) CCGs participating in the PINCER programme. At the beginning of the Digital Pioneer Fellowship, there were no baseline data uploads onto the intended comparative analysis database – CHART Online. A combination of collaborative working and networking has led to significant progress and buy in and Mairead has employed techniques and strategies that she learnt through the Fellowship. In December 2019, there were 279 GP practices signed up to PINCER and 193 of these practices had uploaded their baseline data onto CHART Online. As of January 2020 over 130 pharmacists have been trained, and with the current formation of Primary Care Networks the level of participation is expected to rise.
“I joined the Fellowship programme after receiving encouragement and support from my manager who suggested I apply. I had just started my role at the STP and PINCER was a national project that our team was supporting the roll out of. The programme seemed like a great opportunity to collaborate, further my understanding and training in project management, and get to know other people from different backgrounds and at different stages of their careers. I recognised the value of mentorship from my line manager and I am grateful to have learnt so much from my fellow pioneers as well as the faculty of the programme.
I have found the programme an invaluable experience. It has helped crystallise the area of healthcare I want to develop my career in. I’d like to incorporate the learnings from the programme to facilitate a digital transformation of disease prevention strategies and gain a deeper understanding of behavioural science. I have recently been accepted onto the Health Education England population health fellowship, which starts in February 2020. I hope to use this as a platform to develop my ideas and work with a wider team to offer better patient outcomes through more impactful prevention programmes.”Mairead McErlean