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 PINCER  intervention 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 Medicine 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 main causes include ‘contraindications’ (different drugs used together), failure to take action on computer warnings, lack of monitoring and breakdown of safety systems. PINCER  provides:

  1. A robust, evidence-based 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 at a 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 (Pharmacist-led INformation technology intervention for reducing Clinically important Errors) 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 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

We have met with CCGs in the Yorkshire and Humber region and with Integrated Care System Medicines Optimisation Groups and Boards to raise awareness of PINCER and explain the benefits for patients and health and care systems.

Four CCGs have firmly committed to implement PINCER in autumn 2018:

  • Vale of York CCG
  • Scarborough and Ryedale CCG
  • Barnsley CCG
  • Rotherham CCG

We are in the process of agreeing with West Yorkshire & Harrogate ICS which of its CCGs will implement this autumn.

Next steps

Our aim is to extend the spread of  PINCER to 20 per cent of our 712 GP practices by March 2019 and to build on this implementation in 2019-20 to ensure that patients and practices all over the region are benefitting from improvements to medicines safety in primary care.