Five steps to reducing prescribing errors using PINCER
Dr Sarah Rodgers advises on how to install and run the PINCER trial PRIMIS CHART toolkit at your practice
The PINCER trial was developed as a robust cluster randomised controlled trial to test whether a large complex pharmacist-led IT-based intervention compared with simple feedback could reduce medication error rates within the primary care setting.
The study involved at-risk patients in 72 general practices who were being prescribed drugs that are commonly and consistently associated with medication errors, for instance NSAIDs and beta blockers. The results of the trial, published in the Lancet (February 2012), showed that the PINCER intervention is an effective method for reducing a range of clinically important and commonly made medication errors in primary care.1
As a first step towards the potential rollout of the approach taken in the PINCER trial to general practices in the UK, the research team have collaborated with PRIMIS to update the computerised queries used in the PINCER trial and to make them available to UK general practices through the PRIMIS Query Library.
Here are five steps to running the PINCER queries on your practice system.
1 Register with PRIMIS for membership to PRIMIS Hub
All practices wishing to make use of the PINCER Query Library, developed by PRIMIS, will need to be members of PRIMIS Hub online community. PRIMIS Hub is a vibrant online community and entitles members to a range of products and services from PRIMIS. A basic level Hub membership is completely free and easy to set up.
2 Download CHART and instructions
Once members, practices can log into the PRIMIS Hub online area and visit the CHART area to download the analysis tool needed to run the PINCER query library. This area of the Hub holds full instructions, guidance and information to help practices download, install and use CHART and for obtaining and running the query library.
3 Download and run query libraries
The PINCER query library can be obtained from within the CHART tool once it is installed on a practice PC. Once the PINCER library is installed in CHART, PINCER MIQUEST queries can be prepared to run on the practice clinical system. Instructions for running MIQUEST queries on each GP clinical information system are available in PRIMIS Hub.
4 Import, view, filter and print responses
Once the queries have been run, responses can be loaded into CHART. For each of the PINCER queries, a summary sheet provides an overview of the information contained in the data and highlights patients ‘at risk’. The data can be viewed by individual patient in the datasheet view, which provides pre-loaded filters and the facility for users to define their own custom filters
5 Analyse your data
The aim of the PINCER query library is to identify at-risk patients in general practices who are being prescribed drugs that are commonly and consistently associated with medication errors so that corrective action can be taken to reduce the risk of occurrence of these errors. The PINCER query library consists of eight queries. Using CHART you can identify individual patients for review or highlight areas where practice policy may need to be reviewed.
For example, the query 1 CHART summary sheet will show the number of patients with a past medical history of peptic ulcer who have been prescribed a non-selective NSAID without co-prescription of a PPI. The datasheet can be filtered to show who these patients are, and will give you specific items such as dates and codes of peptic ulcer diagnosis and NSAID/PPI prescribing within the specified time frames.
Key questions for analysing the data
Are all relevant data recorded using the GP clinical information system? Do any paper records also need to be examined as part of this audit?
What proportion of staff prescribing/issuing medication within our practice are aware of correct treatment protocols? [Target 100%] How are staff made aware of and kept informed of such requirements?
How well do we carry out routine repeat medication reviews?
How do we ensure that any functionality in the practice IT system is activated to provide appropriate warnings for all prescribers? How do we encourage prescribers to take heed of contraindication messages on their computer systems?
Within CHART, more information is available to support analysis, including a data analysis and interpretation booklet and more detailed evidence-based summaries produced by the PINCER research team.
Dr Sarah Rodgers is a senior research fellow in the division of primary care at the University of Nottingham
1 Avery AJ, Rodgers S, et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. Lancet 2012; 379: 1310-1319.