Preventing prescribing errors with PINCER

This programme of work is one of seven programmes selected for national adoption and spread across the AHSN Network during 2018-20.

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. Serious errors affect 1 in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.

In 2017, the World Health Organisation (WHO) launched a Global Patient Safety Challenge: Medication without Harm with the aim of reducing the level of severe, avoidable harm related to medicines by 50% over the next five years, globally.

In Kent Surrey and Sussex, we are working to increase the use of a Pharmacist-led INformation technology intervention for reducing Clinically important ERrors (PINCER) to meet this challenge.
The PINCER approach supports GP practices using software systems alongside root cause analysis to identify why mistakes happened and follows a quality improvement approach to tackle these issues ensuring action is taken to reduce the risk of these errors occurring.

In the region where it began, 2.9 million patient records were searched and 21,636 instances of potentially hazardous prescribing were identified using 11 prescribing indicators – it is estimated that approximately half of these needed an intervention to avoid harm, cases that could otherwise have been missed.

Results showed that as a result of the study there was a significant reduction in hazardous prescribing for indications associated with gastrointestinal bleeding, heart failure and kidney injury. An economic analysis showed introducing PINCER was cost effective, demonstrated an increased quality of life for patients with an overall reduction in costs for practices. Overall medication error rates were reduced by up to 50%. It has now been spread to other parts of the country with improved technology and a total of 13 indicators.

The AHSN is supporting the roll out of PINCER across KSS that includes providing support for the implementation of the software and training. Training dates can be found here.

It is anticipated that use of PINCER will result in a reduction in serious medication-related adverse effects, a significant improvement in prescribing safety in primary care and cost savings to the NHS both at practice level and by preventing any hospital admission related to an adverse effect.

When practices are fully trained, it is expected that PINCER will be run twice a year allowing them to benchmark themselves against others both locally and nationally.

For more information please contact Lisa Devine, Programme Manager: