Research issue
Medication errors, particularly those relating to prescribing or insufficient medication monitoring, are often associated with considerable risk of patient harm, including hospital admissions.
The highest rates of medication errors tend to be found in patients taking multiple medications and also in relation to certain drugs that are frequently associated with preventable morbidity e.g. anticoagulants and diuretics.
By identifying interventions aimed at reducing the prevalence of medication errors, this research has potential to improve the quality of care for patients, prevent medication-related harm, and improve the cost-effectiveness of care.
What we are doing about this issue
Our research focuses on investigating the prevalence, nature and causes of medication errors in general practice; evaluating patient safety initiatives, including interventions aimed at reducing the prevalence of medication errors; undertaking epidemiological work to assess the benefits and harms of medicines used in primary care; and assessing the safety of primary care organisations. Much of our research is done in collaboration with colleagues from NIHR Greater Manchester Patient Safety Translational Research Centre.
Issue 1: Safety of prescribing in primary care
We have four broad themes within this area:
- Describing the prevalence and nature of medication errors (PINCER Trial, use of QResearch database, development of NIHR/RCGP prescribing safety indicators)
- Identifying and exploring the underlying causes of medication errors (studies of GP/pharmacy/ hospital computer systems, PRACtICe Study)
- Identifying potentially effective interventions to reduce medication errors (PINCER Trial, electronic clinical decision support, error trapping, educational interventions, pharmacist support, health economic modelling of prescribing safety indicators)
- Designing and testing interventions to reduce medication errors (PINCER Trial, follow-on work from PINCER Trial, Patient Safety Toolkit Study, studies in collaboration with NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre)
Issue 2: Patient safety culture in primary care organisations
- Reviewing patient safety tools for inclusion in a toolkit for general practices (Patient Safety Toolkit Study, studies in collaboration with NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre).
- Eliciting views on safety improvement in primary care (focus group study with primary healthcare professionals and service users to explore their views on the recommendations of the GMC funded PRACtICe study).
- Reviewing the literature of safety management systems in high risk industries in order to identify the important components of a safety management system for use in the primary care setting.
Current projects
Current projects include:
- Developing, testing and implementing the NIHR School for Primary Care Research Patient Safety Toolkit in general practices in England.
- Understanding and appraising the New Medicines Service in the NHS in England.
- Investigating the implantation, adoption and effectiveness of ePrescribing systems in English hospitals: a mixed methods national evaluation.
- Testing the benefits of an integrated safety management system for medicines management in primary care.
- Developing prescribing safety indicators and data extraction methods in UK general practice.
- Evaluation of prescribing safety e-learning materials for GPs.
- GP registrars and safety of prescribing in primary care (First 100 prescriptions project)
Outcomes
In terms of impact, our research meets the challenges of the Quality, Innovation, Productivity and Prevention (QIPP) agenda in that it has the potential to improve quality and safety of care for patients, enhance service delivery, accelerate the translation of evidence to practice and has the potential to provide cost savings to the NHS.
We are currently working closely with NHS England, the National Institute for Health and Care Excellence (NICE) and the Chief Pharmaceutical Officer for England to look at ways of translating our research findings into main-stream general practice.
- Avery AJ, Rodgers S, Cantrill JA, Armstrong S, Cresswell K, Eden M, Elliott RA, Howard R, Kendrick D, Morris CJ, Prescott RJ, Swanwick G, Franklin M, Putman K, Boyd M, Sheikh A. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. The Lancet; 2012: 379(9823): 1310-1319 doi:10.1016/S0140-6736(11)61817-5
- Avery AJ, Anderson C, Bond CM, Fortnum H, Gifford A, Hannaford PC, Hazell L, Krska J, Lee AJ, McLernon DJ, Murphy E, Shakir S, Watson MC. Evaluation of patient reporting of adverse drug reactions to the UK ‘Yellow Card Scheme’: literature review, descriptive and qualitative analyses, and questionnaire surveys. Health Technology Assessment Programme 2011; 15(20):1–234 doi: 10.3310/hta15200
- Avery T, Barber N, Ghaleb M, Dean Franklin B, Armstrong S, Crowe S, Dhillon S, Freyer A, Howard R, Pezzolesi C, Serumaga B, Swanwick G, Talabi O. Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study (PRevalence And Causes of prescrIbing errors in general practiCe). London: General Medical Council, May 2012. Available at: http://www.gmc-uk.org/news/13017.asp
Patient Safety Toolkit named as Top 10 achievement of the NIHR School for Primary Care Research
A project led by Prof Tony Avery, a patient safety toolkit for general practices, has been named as one of the top 10 achievements of the NIHR School for Primary Care Research (SPCR) over the last 10 years.
The Patient Safety Toolkit for General Practice is hosted on the Royal College of General Practitioners (RCGP) website.