In-house pharmacists could help GPs cut drug errors by half
Release Date 21 February 2012
A Reading scientist has co-authored a new study suggesting drug prescription errors could be cut by half if GP surgeries hired their own in-house pharmacists.
Dr Rachel Howard, of the Reading School of Pharmacy, University of Reading, was involved in a major study, published today in the Lancet, which concluded that the number of mistakes could be reduced significantly if GPs introduced an in-house pharmacist-led intervention scheme.
Dr Howard won the 2011 UKCPA/Pfizer Patient Safety Award at the UK Clinical Pharmacy Association/Guild of Healthcare Pharmacists joint conference last year for her work on the project, called PINCER.
The research, a comprehensive study into sustainable ways of preventing patients from being harmed as a result of prescribing errors, was led by Tony Avery, Professor of Primary Health Care in the School of Community Health Sciences at The University of Nottingham and funded by the Patient Safety Research Program of the UK Department of Health.
The results were published on Tuesday 21 February 2012 in the Lancet - one of the world's leading medical journals.
The study involved at-risk patients in 72 general practices taking the drugs that are most commonly and consistently associated with medication errors.
The general practices were randomly allocated to receive either computerised feedback on patients at risk, or computerised feedback with support from a pharmacist to correct any errors detected. When followed up six months later the general practices receiving pharmacist support had significantly fewer prescribing errors.
Dr Howard said: "At present, most pharmacists working in general practices are focussed on reducing the costs of prescribing. In a hospital setting, pharmacists focus on prescribing safety as well as cost control. The same should be true of pharmacists in general practice.
"The PINCER trial demonstrates that, combined with an IT-based intervention, pharmacists from a range of backgrounds can reduce the risk of hazardous prescribing in general practice. This has the potential to reduce the risk of hospital admissions caused by adverse effects from medications."
Professor Avery, who is also a practising GP in Nottingham, has called on the Department of Health and GP clinical commissioning groups to develop a wider roll-out of the intervention scheme.
He said: "Our study has shown remarkable reductions in prescribing errors from an approach that could easily be rolled out to general practices in England and the rest of the UK. Most general practices already have in-house pharmacists, but much of their time is spent controlling prescribing costs. What is needed is a commitment for these pharmacists to spend more of their time on patient safety. Not only would this help prevent unnecessary harm to patients, but it may also reduce the costs associated with dealing with prescribing errors, which sometimes require hospital admission".
How the study was set up
Professor Avery and his team, which involved the University of Manchester, the University of Reading, the University of Otago in New Zealand, and the University of Edinburgh, studied GP practices in Nottinghamshire, Staffordshire and Central and Eastern Cheshire, England.
Practices allocated to the simple feedback system received computerised feedback on patients at risk from medication errors and the practices were given brief written information on the importance of each type of error.
GP surgeries allocated to pharmacist-intervention met with a pharmacist at the beginning of intervention period to discuss the problems identified from the computerised feedback and to agree on an action plan. The pharmacist then spent roughly two days a week for the next 12 weeks dealing with the problems and working to improve safety systems. In some cases, patients were invited into the surgery for a prescription review with the pharmacist, or a GP, or to have a blood test, with the aim of correcting medication errors.
The results of the study
Their results showed that GPs were almost 50 per cent less likely to make errors in the monitoring of older people taking ACE inhibitors or diuretics, 42 per cent less likely to make errors in prescribing non-steroidal anti-inflammatory drugs to patients with a history of peptic ulcer (including stomach ulcer), and 27 per cent less likely to make errors in prescribing beta-blockers to patients with asthma.
Professor Avery said: "We know that GPs are aware of the risks of the drugs most commonly associated with adverse events, but errors do occur and our study has shown an effective way of dealing with them. We believe that there is an urgent need to roll out this pharmacist-led intervention to general practices throughout the country to avoid unnecessary errors in the future."
For more information and interview requests contact Pete Castle, University of Reading press office, on 0118 378 7391 or firstname.lastname@example.org.
Further details on the study are available from Professor Tony Avery, University of Nottingham, on +44 (0)115 8230207, email@example.com, or Sarah Rodgers (Trial Coordinator), on +44 (0) 115 8231435, firstname.lastname@example.org or Lindsay Brooke, Communications, The University of Nottingham on +44 (0)115 9515751, email@example.com.
Notes to editors:
The School of Chemistry, Food and Pharmacy at the University of Reading is a multi-discipline School with research and teaching activities covering a broad range of science. Degrees are offered in Pharmacy, Chemistry (and associated 'Chemistry with' programmes), Food Science, Food Science with Nutrition and Food Technology. The School also offers a number of continuing professional development courses.
Research activities are very broad, ranging from pure and applied life science through material science to physics. Areas of interest include pharmacology, drug design, development and delivery, functional foods, nutrition, flavour chemistry, polymer and nanoscience, atmospheric chemistry and the physics of surfaces.