The programme

Prescribing errors in general practice are not common – but when they happen they can be an expensive cause of safety incidents, illness, hospitalisation and even deaths.

The Pharmacist-led information technology intervention for reducing clinically important errors (PINCER) 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 reduce the risk.

PINCER is one of the Medicines Optimisation projects selected for national adoption and spread across the AHSN Network in 2018-2020.

Why?

Medicines errors happen for a number of reasons but the main causes include ‘contraindications’ (different drugs used together), failure to take action on prescribing system computer warnings, lack of monitoring and breakdown of safety systems. PINCER  provides:

  1. A robust, evidence-based National Institute of Clinical Excellence (NICE) approved intervention proven to have clinical impact
  2. Pharmacist-led review of prescribing and system issues, to significantly reduce rates of clinically important and commonly made prescribing errors in primary care
  3. Comparative data on numbers of at risk patients at a practice, CCG population and national level

How are we helping?

General practice prescribing error rates are estimated to be five per cent, with serious errors affecting 1 in 500 of all prescription items.

PINCER helps support improvements in  medicines safety by:

  • 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 GP practice
  • Establishing action planning to improve systems and reduce risk
  • Scale up PINCER using a large-scale Quality Improvement Collaborative approach

In the region where PINCER was first implemented in 2015, 2.9 million patient records have been searched and 21,617 instances of potentially hazardous prescribing have been identified. It is estimated that approximately half of these needed an intervention to avoid harm, cases that could otherwise have been missed.

Yorkshire & Humber AHSN is committed to giving our partner CCGs and GP practices access to PINCER and the associated pharmacy team training to use it at no cost over the next two-three years.

“PINCER is a really worthwhile intervention. It has led to complex reviews being carried out by GPs facilitated by practice pharmacists, which will ultimately improve patient safety.” Medicines Management Team  

Our impact to date

To date, our partner PRIMIS has delivered training to teams covering 170 GP practices. As of 25 March 2019, over 130 of these practices have run PINCER audits and uploaded the results into the PRIMIS portal.

The CCGs involved are:

Airedale, Wharfedale and Craven CCG

Barnsley CCG

Calderdale CCG

Greater Huddersfield CCG

Harrogate and Rural CCG

North Kirklees CCG

Rotherham CCG

Scarborough and Ryedale CCG

Vale of York CCG

Wakefield CCG

Next steps

We will continue to work with PRIMIS to deliver PINCER training and support GP practices with implementation through 2019-20.

If you would like to know more about PINCER or are interested in being part of the next wave of PINCER implementation during 2019-2020, please contact the Programme Manager Vicki Linford