National medication errors project shows reduction in hazardous prescribing

The PINCER project has been shown to be an effective method for reducing a range of medication errors, an evaluation of the national roll-out finds.

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An evaluation of the national roll-out of the ‘Pharmacist-led Information Technology Intervention for Medication Errors’ (PINCER) project has shown that it has led to reductions in hazardous prescribing, particularly for prescribing indicators associated with gastrointestinal bleeding.

PINCER, which was commissioned by NHS England and introduced nationally from 2018, involves searching GP clinical systems using computerised prescribing safety indicators to identify patients at risk from their prescriptions, and then acting to correct the problems, with pharmacist support. 

As of 3 April 2020, 130 (68%) clinical commissioning groups in 14 academic health science network (AHSN) areas had engaged in the PINCER roll-out. A total of 2,430 general practices had uploaded baseline data to the PINCER comparative analysis service, showing that a minimum of 23.35 million patient records had been searched to identify potentially hazardous prescribing using 13 evidence-based prescribing safety indicators.

In total, 187,534 at-risk patients were identified in at least one prescribing safety indicator at baseline, giving an overall prevalence of 8.03 patients at risk of medication error per 1,000 registered patients.

Analysis of baseline and follow-up data provided by 1,060 of the general practices revealed a 14% reduction in the absolute number of patients at risk of a medication error, from 92,762 to 79,375 patients.

The largest reduction was in the number of at-risk patients identified in at least one gastrointestinal bleed indicator, where a 26% reduction was observed, from 40,720 patients to 30,161 patients.

Clare Howard, clinical lead for medicines optimisation at Wessex AHSN, described the results as “impressive”.

“AHSNs were commissioned nationally to support the early adoption of this important medication safety intervention across England and we are fantastically proud of the results delivered with partners that are highlighted in this interim report,” she said. 

“PINCER will be a key factor to identify patients at risk of harm as part of the PCN [primary care network] DES [direct enhanced service].”

Howard said the national commission for AHSN support would end in March 2021, so they were now working to ensure that local systems were able to “build on the learning from the past three years to make this core practice”.

According to the progress report, more than 1,138 pharmacists have been trained to deliver the PINCER intervention through a combination of eLearning tools, online resources and face-to-face action learning set sessions.

Findings from the PINCER trial, published in The Lancet in 2012, demonstrated that PINCER was an effective method for reducing a range of clinically important and commonly made medication errors in primary care. PINCER is now incorporated into national guidelines to support medicines optimisation by the National Institute for Health and Care Excellence.

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Citation
The Pharmaceutical Journal, PJ October 2020, Vol 305, No 7942;305(7942):DOI:10.1211/PJ.2020.20208377