PINCER quality improvement tool turns five

The PINCER intervention is recommended in a Department of Health and Social Care report, as the PINCER quality improvement tool turns five

A recent Department of Health and Social Care commissioned report on reducing medication-related harm has recommended the roll-out of proven interventions such as PINCER as a way to improve patient safety in primary care.

PINCER is a successful, pharmacist-led IT-based intervention, for reducing important and common medication errors in general practice prescribing and has been incorporated into National Institute for Health and Care Excellence (NICE) Medicines Optimisation Clinical Guideline.

PRIMIS and the PINCER research team are celebrating the first five years of the PINCER quality improvement tool which has helped GP practices significantly reduce hazardous prescribing with potential benefits to thousands of patients, and the NHS, from this cost-effective intervention.

PRIMIS has been instrumental in the development and ongoing management of the PINCER quality improvement tool (developing and updating code groups and business rules) and providing the information technology to support the work of the pharmacists, general practices and research teams as part of the PINCER intervention.

The PINCER quality improvement tool is used to identify at-risk patients who are being prescribed drugs that are commonly and consistently associated with medication errors so that corrective action can be taken to reduce potential patient harm. It 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’ use the results obtained via the tool, to work with individual general practices to develop an action plan to address the identified issues. Pharmacists and pharmacy technicians then work with and support practice staff to implement the action plan.

Key statistics for the PINCER quality improvement tool since its launch in February 2013:

• The PINCER quality improvement tool has been downloaded by around 2,400 practices across 198 CCGs (approximately 30% of all practices in England)
• We have worked with key stakeholders to maximise rollout of the PINCER intervention including:
  • Wessex AHSN
  • Northern Ireland Health and Social Care Board
  • Newcastle Gateshead CCG
  • Greater Manchester AHSN

Scaling up PINCER across the East Midlands

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.

A more detailed evaluation of the rollout in the East Midlands is being done as part of an NIHR funded programme grant called PRoTeCT, to explore whether implementing PINCER reduces avoidable medication-related harm and hospital admissions.

The future of PINCER

The PINCER programme continues to gain momentum, thanks to recent funding secured from the Health Foundation, as part of an innovative Exploring Social Franchising and Licensing programme to roll PINCER out nationally. Following the successful roll out of PINCER across the East Midlands and Wessex AHSNs, PRIMIS and the PINCER research team are working closely with colleagues across all AHSNs on options for its national implementation.

PRIMIS is currently developing the PINCER tool so that it is fully SNOMED CT compliant, providing peace of mind for practices and pharmacists that it can be used long into the future.

Full details of the current PINCER quality improvement tool and scaling up projects can be found online: nottingham.ac.uk/primis/tools-audits/tools-audits/pincer/pincer.aspx

Notes

The original PINCER trial, led by Professor Tony Avery and Dr Sarah Rodgers from the University of Nottingham, was developed 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 original study conducted by the Universities of Nottingham, Manchester and Edinburgh involved at-risk patients in 72 general practices who were being prescribed drugs that are commonly and consistently associated with medication errors. The results of the trial (published in The Lancet in 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.