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  • Led by Lincolnshire Community Health Services NHS Trust, with the University of Lincoln, the University of Nottingham, PRIMIS and the East Midlands Academic Health Science Network.
  • Implemented between September 2015 and April 2017 in 12 clinical commissioning groups (CCGs) across the East Midlands, covering 370 general practices.
  • Involved scaling up a proven pharmacist-led information technology intervention (PINCER) to improve medication safety.
  • Resulted in reductions in the proportion of patients being exposed to hazardous prescribing.

Medication errors in general practice are a frequent and expensive preventable cause of patient safety incidents. The rate of errors is estimated to be 5% of prescription items, with around one in 550 items containing a potentially life-threatening error.

These errors can stem from clinical, human and social factors, including knowledge gaps about contraindications, failure to heed computerised warnings, failure to arrange appropriate monitoring, and failure of safety systems to prevent errors from reaching the patient.

A pharmacist-led information technology intervention for reducing medication errors in general practice (PINCER) has been found to be acceptable, effective and cost-effective in reducing rates of hazardous prescribing.

The PINCER intervention 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.

This Scaling Up Improvement project involved PINCER being implemented in 12 CCGs across the East Midlands, covering 370 general practices. A total of 2.97 million patient records were searched, and 22,105 instances of potentially hazardous prescribing were identified.

Statistical analysis showed the PINCER intervention was associated with a reduction of around 24% in the proportion of patients in participating practices being exposed to at least one type of hazardous prescribing. The reductions were most notable in relation to prescribing safety indicators associated with risk of gastrointestinal bleeding, where the overall reduction was around 31%.

The level of uptake was high, with 94% of eligible practices completing the implementation. The extent to which stakeholders engaged with PINCER was a crucial factor for uptake, use and sustainability.

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