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Preventing prescribing errors in south London with PINCER

Over the past fortnight, almost 90 GP pharmacists have taken part in training on software that aims to reduce prescribing errors. PINCER searches GP clinical systems using computerised prescribing safety indicators to identify patients at risk from complications that arise owing to being prescribed multiple medicines that don’t always work together and then acting to correct the problem. The training sessions mean that GP Pharmacists in eight south London CCGs can now use the software in their practises.

“I can’t wait to use the PINCER too, to help reduce errors and adverse reactions. This will help complement our role as clinical pharmacists.” Reena Rabheru-Dodhy, Senior Primary Care Pharmacist

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. Serious errors affect one in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.

Outcomes of a trial published in the Lancet showed a reduction in error rates of up to 50% following adoption of PINCER – a pharmacist led system which acts as a risk assessment tool to identify and flag errors in general practice prescribing.

These original PINCER indicators have been incorporated into National Institute for Health and Care Excellence (NICE) Medicines Optimisation Clinical Guideline (May 2015).

Mandeep Butt, Communities of Practice, who is part of the Health Innovation Network team coordinating the training was delighted by the response from the trainees;.  

I look forward to working with the amazing practice based pharmacists and technicians we have met over the last 2 weeks. Their enthusiasm was infectious!” 

Further training sessions will be happening in May and June. For more information or sign up for the training, please contact hin.southlondon@nhs.net

More about PINCER:

Developed by The University of Nottingham, the PINCER intervention developed as part of PRIMIS audit tools is led by primary care pharmacists and pharmacy technicians.

With funding and support from the Health Foundation and East Midlands AHSN, PINCER was rolled out to more than 360 practices across the East Midlands between September 2015 and April 2017.

This involved:

  • 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 practice
  • Establishing action planning to improve systems and reduce risk
  • Establish action planning to improve systems and reduce risk
  • Scale up PINCER using a large-scale Quality Improvement Collaborative approach.
  • More than 2.9 million patient records were searched, and 21,617 cases of potentially hazardous prescribing were identified.

The programme is one of the interventions selected for national adoption and spread across the AHSN Network and has so far demonstrated great results in a preliminary study, where there was a significant reduction in hazardous prescribing for indicators associated with gastrointestinal bleeding, heart failure and kidney injury.