PINCER (pharmacist-led IT-based intervention to reduce clinically important medication errors)

PINCER (pharmacist-led IT-based intervention to reduce clinically important medication errors)

PINCER is a proven pharmacist-led IT-based intervention to reduce clinically important medication errors in primary care. PINCER has been rolled out across the West Midlands region in 252 practices across the region. The was largest and quickest uptake of PINCER across the country and the project overachieved its 2 year target in 1 year.

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Overview

PINCER is a proven pharmacist-led IT-based intervention to reduce clinically important medication errors in primary care. The intervention comprises three core elements:

  • An integrated search on GP computer systems to identify patients at risk of potentially hazardous prescribing using a national set of 14 evidence based validated prescribing safety indicators. Searches allow for stratification and prioritisation of patients at highest risk, identifying patients who are at more than one type of risk.
  • Pharmacists and Pharmacy Technicians, specifically trained to deliver the intervention provide an educational outreach intervention, where they meet with GPs and other practice staff to implement an agreed action plan for patients identified at high risk.  The intervention uses academic detailing and root cause analysis (RCA) to minimise future risk, thereby improving prescribing and medication monitoring systems.
  • Access to comparative analysis of prescribing safety data called CHART ONLINE, allowing practices to compare results from baseline to post PINCER intervention. Practices can quickly identify trends and cause for action; by uploading non patient identifiable data at 6-12 monthly intervals. Analysis at practice, CCG, STP, regional and national level allows benchmarking, monitoring and comparison.

PINCER has been rolled out across the West Midlands region in 252 practices across the region. The was largest and quickest uptake of PINCER across the country and the project overachieved its 2 year target in 1 year. 

Impact & Outcomes

Across England, a total of 2,430 practices have uploaded baseline data to the national PINCER comparative analysis service CHART Online. A tenth of these practices are from the West Midlands with 252 practices uploading baseline data: identifying 16,717 patients within the West Midlands AHSN at risk of harm from prescribing errors. Prevalence is 8.08 patients at risk of harm per 1,000 registered patients, averaging a mean of 66.3 patients per practice.

2018 patients were highlighted at risk of harm in the GI bleed indicator: patients prescribed aspirin in combination with another antiplatelet drug without co-prescription of an ulcer-healing drug, The ratio of rate was greater than 20% the national average  Prescription of an antiplatelet drug without co-prescription of an ulcer-healing drug, to a patient with a history of peptic ulceration was another outlying indicator, suggesting a need for education / intervention around antiplatelet prescribing and the risks imposed on GI bleeding and subsequent increased risk of hospital admission (up to 12.3% bleeding admission rate). Prescribing behaviour linked to increased risk suggests multi-factorial variables including hospital admission or treatment, including one study which found 40% of patients taking a NSAID are discharged from hospital without concurrent use of GI protection. 

Practices implementing PINCER upload their data to CHART Online again once they have completed each QI cycle (approximately six-monthly). Of the 2,430 practices that have uploaded baseline data to CHART Online nationally, almost half (1,060) have uploaded follow-up data on at least one occasion. Analysis of follow-up data from all 1,060 practices shows greatest reductions can be seen for those indicators associated with GI bleed which showed a decrease of 25.9% or 10.599 patients at risk. Practices within the West Midlands have yet to complete their first QI cycle, but from a handful of practices that have (n=16), a similar reduction of 25.1% (108 patients) is evident. Comparative results can be seen for a reduction in the number of patients at risk of monitoring errors and patients identified in at least one other indicator (heart failure, Acute Kidney Injury, or exacerbation of asthma). 

The West Midlands has successfully embraced the adoption of PINCER and this year will focus on the continued and sustainable use of the innovation to reduce the number of prescribing errors moving to a more virtual way of implementation and adoption.