Making prescribing safer with PINCER

16 Mar


Recent news reports brought home the importance of reducing medication errors in healthcare. The news coverage highlighted that research, conducted by university academics in Manchester, Sheffield and York estimated 230,000 errors each year in the administering of medication in the NHS, contributing to 22,000 deaths. While the majority of these errors are spotted (and corrected) at the point of error, or do not threaten patient safety, a drastic reduction in the number of errors is now being called for. A change from the current culture of blame to a learning culture is one solution being discussed, but there are other, more practical interventions already in existence.

Once such intervention, called PINCER, is a pharmacist-led intervention developed at the Universities of Nottingham, Manchester and Edinburgh. PINCER has been shown to be an effective method for reducing a range of clinically important and commonly made medication errors in primary care.  Using a set of ‘prescribing safety indicators’ which identify common, but potentially harmful, medication prescribing errors, the intervention involves:

  •         Running searches on GP computer systems to identify patients at risk from common and important prescribing and drug monitoring errors
  •         Pharmacists – trained in the PINCER approach – working with individual general practices to develop an action plan to address the issues identified
  •         Pharmacists (and pharmacy technicians) working with and supporting general practice staff to implement the action plan.

With funding from the Health Foundation and East Midlands Academic Health Science Network, PINCER has been rolled out to 360 practices across the East Midlands since September 2015.  Over 2.9 million patient records have been searched, identifying over 21,000 instances of hazardous prescribing. Applying trends from data collected as part of the evaluation of the rollout, it is estimated that over 10,500 patients have received an active intervention resulting in safer care as a direct benefit of implementing the intervention.

The PINCER intervention has been incorporated into national guidelines to support medicines optimisation by NICE and a more detailed evaluation of the rollout in the East midlands is being done as part of a new NIHR funded programme grant called PRoTeCT to explore whether implementing PINCER reduces avoidable medication-related harm and hospital admissions.

A Patient Safety Toolkit for general practice

15 Mar


The development and testing of a Patient Safety Toolkit for general practice has taken place over a number of years by a partnership of researchers at the Greater Manchester PSTRC in Nottingham (including Tony Avery, Brian Bell, Sarah Rodgers, Ndeshi Salema, Rachel Spencer) and Manchester (including Stephen Campbell, Kathy Perryman) the NIHR School for Primary Care Research at the Universities of Birmingham, Keele, Oxford and Southampton, as well as the University of Exeter.

The Patient Safety Toolkit is hosted on the Royal College of General Practitioners (RCGP) website. The RCGP is a network of over 52,000 family doctors. The Toolkit is important in preventing patients from being harmed. It is designed to be used by any general practice in the UK and covers the following topics:

  • safe systems
  • safety culture
  • communication
  • patient reported problems
  • diagnostic safety
  • prescribing safety

This range of topics addresses the fact that patient safety is complex and multidimensional. Improving patient safety requires preventing, identifying and addressing issues using practical and actionable information. The collection of tools is hosted on a single platform, which makes it easy to use and enables general practices to identify safety deficits. They can then review and change procedures to improve their patient safety across a key set of patient safety issues.

The research team has published a summary paper, which has been published in the Journal of Patient Safety: A Patient Safety Toolkit for Family Practices

Improving patient safety: linking PSTRC research and expertise to policy and practice

14 Mar

Nav Kapur

Linking up with policy-makers and clinical services is an important part of the work of the NIHR Greater Manchester PSTRC.  Nav Kapur, who is a Professor at the University of Manchester and one of the Research Leads for the Centre, really values the wider engagement he has had with NICE (he chaired the NICE self-harm and depression guidelines), the Department of Health and Social Care,  and Health Education England amongst others.  

Nav says: “We are proud to be a leading centre for research into self-harm and suicide and it’s been a privilege to inform policy and practice.  As an academic, being involved in guideline development allows you to get a wider view of the worldwide literature and its impact on patients.  As a clinician, I like the fact that being involved in guidelines and policies allows you to improve the care of all patients, not just the patient in front of you.”

He continues: “As part of my role as a member of the National Suicide Prevention Strategy Advisory Group for England I contributed to the new suicide prevention strategy, particularly its emphasis on self-harm, as well as contributing to initiatives on confidentiality and responding to new methods of suicide.  My work with Health Education England aims to develop competencies for all NHS staff in the assessment of patients who present with suicidal thoughts or self-harm.” 

Nav also values his role contributing to the induction of new chairs for NICE Guidelines. He explains: “In some ways I find it quite strange that I am now one of the most experienced guideline chairs!  But I really enjoy sharing my experiences of chairing groups and guideline development with people just embarking on the process and I hope they find it helpful too.” 

Nav and colleagues including Roger Webb and Caroline Sanders who lead the Safety in Marginalised Groups theme are looking forward to contributing further to guidelines and policy and practice.  In particular the planned work on the management of self-harm, the safety of mental health services, and improving care for marginalised groups could have a major impact on patient safety and patient care.        

PhD fellow focus: Lukasz Cybulski

2 Feb

In this series, we meet our new PhD fellows to find out what they will be researching and what they hope to achieve.

Lukasz Cybulski started his PhD in September 2017. He has a background in research and mental health work with an interest in the synthesis of public health policy, the use of research findings in the ‘real-world’ and ways of increasing research transparency and reproducibility. The opportunity to combine these interests is what drew him to the projects at the Greater Manchester Patient Safety Translational Research Centre.

His PhD will focus on self-harm and suicide in children, adolescents and young adults. The epidemiology (the study of how diseases affect the health and illness of populations) of self-harm and suicide has not been extensively studied among registered primary care patients. The majority of people diagnosed with a mental health disorder, including conditions such as depression, anxiety disorders and eating disorders, are rarely referred to, or treated by, specialist mental health services.

Lukasz will investigate this topic using a nationally representative group of primary care patients,  linking with routinely collected clinical datasets and national mortality records. This will provide a unique platform for investigating people diagnosed with ‘mild to moderate’ mental health problems, their clinical management across healthcare sectors, and their subsequent risks of nonfatal and fatal suicidality and other causes of premature death. Epidemiological studies of this nature allow for the identification of populations at particular risk, and aid the development of clinical guidelines that maximise patient safety.

Health economics and patient safety

2 Feb

Health economics is a field of study concerned with the efficient use of resources within the health and social care sector. Efficiency is measured as a combination of patient health outcomes (such as the number of detected cancers, lives saved or quality adjusted life years (QALYs)), with the resource input (costs for treatment etc.).  Health economics not only involves looking at the cost of a healthcare intervention, technology or programme being studied, but also the effectiveness of it. An economic evaluation can be made from different perspectives: that of the health and social care provider (i.e. NHS), the stakeholder, or from a societal perspective, among others. Given the fixed budget the NHS faces, resources should be spent as efficiently as possible.

The more patient safety measures that are used in health and social care, the higher the cost. Therefore, policymakers need guidance on what patient safety interventions to implement to maximise health, care and economic gains. This is not questioning the necessity of patient safety measures themselves, but trying to identify the most efficient use of the existing resources to increase the benefit for patients. Health economics uses different types of evaluations to estimate the effects on the population and the cost to the NHS of the intervention being studied.

Building on success: Safety Informatics

1 Feb


Digital technologies are becoming more commonplace within the NHS and in our daily lives, producing rich data on all aspects of our health and care. Connecting the data which is held in, for example, smartphones (such as step counters) and our own Electronic Health Records in primary and secondary care, can help us to gain a deep understanding of patient safety issues and the factors that increase risks of harm.

The Safety Informatics theme will continue its work from the first NIHR Greater Manchester PSTRC, using the wealth of health data which is collected about us, to help prevent harm in our everyday healthcare experiences. One example of the work taking place in Safety Informatics theme is the ACTION intervention, which uses Electronic Health Record data to give feedback to healthcare professionals in Greater Manchester on prescribing safety and management of long term conditions, which creates a ‘learning health system’. The theme will also work on the surveillance of system-wide diagnostic error; patient-led monitoring of test results; and monitoring late effects of cancer treatment.

Find out more on the Safety Informatics web page.