Using software to prevent hazardous prescribing

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. The PINCER intervention is led by primary care pharmacists and pharmacy technicians. It involves searching GP clinical systems using computerised prescribing safety indicators to identify patients at risk from their medications and then acting to correct the problem.

Serious prescribing errors affect one in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.

Outcomes of a trial published in the Lancet showed a reduction in error rates of up to 50% following adoption of PINCER – a pharmacist-led IT intervention for reducing clinically important errors in general practice prescribing.

With funding and support from the Health Foundation, PRIMIS (Primary Care Information Services), and the East Midlands AHSN, PINCER was rolled out to more than 360 practices across the East Midlands between September 2015 and April 2017.

This involved:

• Using software to search clinical systems to identify patients at risk of hazardous prescribing
• Conducting clinical reviews of patient notes and medication
• Carrying out root cause analysis and providing feedback to the practice
• Establishing action planning to improve systems and reduce risk
• Establish action planning to improve systems and reduce risk
• Scale up PINCER using a large-scale Quality Improvement Collaborative approach.

More than 2.9 million patient records were searched, and 21,617 cases of potentially hazardous prescribing were identified.

Preliminary results showed that because of the study there was a significant reduction in hazardous prescribing for indicators associated with gastrointestinal bleeding, heart failure and kidney injury.

PINCER was subsequently selected for national adoption and spread across the AHSN Network in 2018-2020, with all AHSNs supporting their local healthcare systems to adopt the intervention.

At the end of the AHSN programme, PINCER had rolled out to 41% of GP practices in England and more than 2,250 health care professionals were trained to deliver the PINCER intervention.

Over the period the intervention was supported by the AHSNs, 216,626 at-risk patients have been identified in at least one prescribing safety indicator – equivalent to 8.14 per 1,000 population. Analysis of follow-up data has shown sustained reductions for those indicators associated with gastrointestinal bleeding, a common cause of medication-related hospital admissions. As well as improving the safety of those patients identified by the searches, the addition of dedicated pharmacist support in the PINCER intervention works to improve systems to avoid future errors – creating even wider sustained benefits.