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In-house medication reviews prevent prescribing errors

By Lilian Anekwe

Using pharmacist-led interventions in general practice can prevent prescribing and monitoring errors, according to the results of a Department of Health-funded trial by leading GP academics.

The UK-led trial compared 72 practices in England randomised to either pharmacist-led interventions or ‘simple feedback' generated by practice computers.

The researchers found the pharmacist interventions achieved greater reductions in the rate of common prescribing pitfalls after six and twelve months, compared with computer-generated warnings alone.

Practices allocated to the simple feedback arm received computer warning of patients identified as at risk from medication errors, and a nominated member of the practice was also given brief written information on the importance of each type of error.

GPs in practices in the intervention arm met with pharmacists at the beginning and end of the intervention period to discuss the computer-generated alerts. Patients were also invited into the surgery for a prescription review with the pharmacist, or a member of the general practice team, with the aim of correcting medication errors.

The primary outcomes were the proportion of patients in each practice with a history of peptic ulcer prescribed NSAIDs without also being prescribed a PPI, a diagnosis of asthma prescribed beta-blockers, or patients aged 75 years and older receiving long-term prescriptions for either an ACE inhibitor or loop diuretic without a recorded renal function and/or electrolytes result in the preceding 15 months.

Compared to those in the simple feedback arm of the trial, after six months GPs in the pharmacist-intervention arm practices were 42% less likely to make errors in NSAID prescribing, 27% less likely in beta-blocker prescribing and 49% less likely when prescribing ACE inhibitors or diuretics. All differences were significant.

After 12 months GPs in the pharmacist intervention group were also significantly less likely to make medication monitoring errors in two of the three primary outcome measures compared with those in the simple feedback arm, but there was no difference in the rate of NSAID errors.

Lead researcher Professor Tony Avery, head of the division of primary care at the University of Nottingham and a GP in the city, said he was confident the errors analysed in the study were problems facing most general practices, and called on the National Patient Safety Agency to develop a wider roll-out of the intervention.

‘The trial has shown that a complex pharmacist-led IT-based intervention can significantly reduce the numbers of patients at risk from clinically important prescribing and monitoring errors.'

‘The UK Government has demonstrated a strong commitment to reducing errors in the NHS. The priority now must be to find effective, acceptable and sustainable ways of preventing patients from being harmed as a result of such errors.'

The trial report is available on the University of Birmingham website.

Using pharmacist-led interventions in general practice can prevent prescribing and monitoring errors, the study found Using pharmacist-led interventions in general practice can prevent prescribing and monitoring errors, the study found Picking up the pieces after discharge

Click here to read a successful example of a pharmacist-led scheme

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