School of Medicine PINCER in practice Medicines Use And Safety Network Event 25th June 2015 Gill Gookey Primary Care Pharmacist Rushcliffe CCG & University of Nottingham
Plan for the presentation: Brief overview of the PINCER Trial How to run the PINCER queries Implementing the PINCER approach
The PINCER Trial A cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices The Lancet, 2012;379:1310 1319 doi:10.1016/s0140-6736(11)61817-5
Patients with a history of peptic ulcer who have been prescribed a non-selective non-steroidal antiinflammatory drug (NSAID) without co-prescription of a proton-pump inhibitor (PPI) Patients with a history of asthma who have been prescribed a beta-blocker Patients aged 75 years and older who have been prescribed an angiotensin converting enzyme (ACE) inhibitor or a loop diuretic long term who have not had a computer-recorded check of their renal function and electrolytes in the previous 15 months Women with a past medical history of venous or arterial thrombosis who have been prescribed combined hormonal contraceptives (CHC) PINCER Query Library Patients receiving methotrexate for at least 3 months who have not had a recorded full blood count (FBC) or liver function test (LFT) within the previous 3 months Patients receiving warfarin for at least 3 months who have not had a recorded check of their international normalised ratio (INR) within the previous 12 weeks Patients receiving lithium for at least 3 months who have not had a recorded check of their lithium concentrations in the previous 3 months Patients receiving amiodarone for at least 6 months who have not had a thyroid function test (TFT) within the previous 6 months
School of Medicine Using Information technology in PINCER 1. CHART software installed on GP practice computer http://www.nottingham.ac.uk/primis/tools-software/chart/chart.aspx 2. CHART software used to download the PINCER Query Library http://www.nottingham.ac.uk/primis/tools-audits/list-of-audit-tools/ pincer.aspx 3. PINCER Queries run on GP clinical system using MIQUEST software. Results displayed in CHART 4. Data provided to GP practices at individual patient level, with those patients at risk highlighted
General Practice view
General Practice/CCG Views We have worked with PRIMIS to develop aggregated views of anonymised patient data using CHART Online This allows practices to view their results in relation to other practices within their CCG and see improvements over time With agreement of the practice, anonymised summary data is uploaded to CHART Online via the internet, aggregated and made available (through PRIMIS) to the GP practices themselves and the CCG
PINCER interven.on - it was the pharmacists that made the difference! Interrogate data / clinical systems Meet with practice Re-run PINCER Focus on systems, not individuals Feedback, education and RCA Implementation Action plan - with named, relevant staff to drive change
PINCER Myth Buster I need to achieve zero patients at risk in every indicator The GPs will not like it Nolan is complicated It will take too much time to do I will use PINCER in the same way in each practice I will need lots of specific training
To summarise Using the PINCER intervention is a useful litmus test into practice prescribing. More indicators are likely to be available in the future. Health Foundation scaling up improvement funding is allowing roll out of PINCER across the East Midlands. PINCER is included in the NHS England Medicines Safety Dashboard.
Thank you for listening Any comments/question? Further information available from: gillian.gookey@rushcliffeccg.nhs.uk tony.avery@nottingham.ac.uk sarah.rodgers@nottingham.ac.uk
PINCER intervention supported by NICE The intervention has now been supported by NICE in its Medicines Optimisation Clinical Guideline published 04/03/15 and available at: http://www.nice.org.uk/guidance/ng5/evidence PINCER is specifically mentioned as follows (p.35): Organisations and health professionals should consider applying the principles of the PINCER intervention to reduce the number of medicines-related patient safety incidents, taking account of existing systems and resource implications. These principles include: using information technology support using educational outreach with regular reinforcement of educational messages actively involving a multidisciplinary team, including GPs, nurses and support staff having dedicated pharmacist support agreeing an action plan with clear objectives providing regular feedback on progress providing clear, concise, evidence-based information.
PINCER resources Instructions on installing CHART software, downloading the PINCER Query Library, running the queries and uploading the results to CHART Online available from the PRIMIS website: http://www.nottingham.ac.uk/primis/documents/information/ howtogeta-primis-audittool.pdf Details showing how general practices can download the computer queries used in the PINCER trial: Rodgers S. New PINCER Query Library Tool to support safer prescribing. Prescriber 2013; 24(6): 11-14 (19 March 2013) DOI: 10.1002/psb.1027 http://onlinelibrary.wiley.com/doi/10.1002/psb.1027/pdf Rodgers S. Five steps to reducing prescribing errors using PINCER. Pulse Today 12 February 2013 http://www.pulsetoday.co.uk/your-practice/practice-topics/it/-fivesteps-to-reducing-prescribing-errors-using-pincer/20001835.article PINCER Query Library Evidence-Based Summaries imbedded in the software
School of Medicine PINCER publications
Further information Please see the following press releases: University of Nottingham EMAHSN http://blogs.nottingham.ac.uk/pressoffice/ 2015/01/30/600000-initiative-will-help-savelives-across-the-east-midlands/ http://emahsn.org.uk/news/600-000-to-willhelp-save-lives-and-improve-safety-forpatients-across-the-east-midlands
CHART on-line- General practice/ccg view
CHART on-line - General practice/ccg view