The Oxford AHSN supported the roll-out of PINCER – a proven pharmacist-led IT-based intervention to reduce clinically important medication errors in primary care. PINCER was one of seven programmes selected for national spread and adoption by all England’s 15 AHSNs in 2018-20. The Oxford AHSN and its partner Clinical Commissioning Groups are working with GP practices to implement PINCER. Over 200 practices did so by November 2019, with 190 pharmacists/GPs trained. Six month data from 25 pilot practices showed over 80% reduced numbers of at risk patients against at least five PINCER indicators.
- We are working closely with Oxfordshire, Berkshire West, East Berkshire and Buckinghamshire CCGs to implement PINCER
- Since April 2019, PRIMIS (which developed PINCER) and the Oxford AHSN have facilitated PINCER action learning sets across 13 localities and trained over 230 people
- As of September 2020, over 210 GP practices have implemented PINCER in their practices and are currently working towards reducing risks around hazardous prescribing
- As of April 2020, across the Thames Valley region there has been an 18% reduction in the number of at-risk patients identified in at least one prescribing safety indicator and a 30% reduction in the number of at-risk patients for indicators associated with a gastro-intestinal bleed
- The Oxford AHSN has been working closely with partners to ensure PINCER is sustainable and long-term benefits can be realised.
What is PINCER?
The PINCER intervention comprises three elements:
- Conducting GP system searches to identify patients at risk from prescribing errors
- Pharmacists working with practices to develop an action plan to prevent future hazardous prescribing
- Pharmacists working with and supporting practice staff to implement action plan
PRIMIS and the University of Nottingham have developed the PINCER tool, an extension of the PRIMIS CHART Query Library that contains important PINCER prescribing safety indicators.
- asimple intervention to reduce the level of harm from medicines that we expose our patients to
- effectively delivered with only a small amount of resource from a pharmacist or pharmacy technicians
PINCER is not:
- Onerous. PINCER can be delivered with minimal additional resource
- Rigid and inflexible. PINCER can be adapted to fit practice working
Why is there a need for PINCER?
- Prescribing errors in general practice are a significant and costly cause of safety incidents, morbidity and deaths.
- It has been estimated that 66 million potentially clinically significant errors occur each year, 71% of which are in primary care (EEPRU 2018).
- Serious errors affect one in 550 prescription items (Avery 2013) while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.
What is the evidence for PINCER?
The PINCER intervention was shown to be effective at reducing medication related errors through a cluster-randomised trial published in the Lancet (Avery 2012). The trial compared two groups of GP practices using the same prescribing indicator searches. A ‘simple feedback’ group (n=36) were provided with details of patients identified in searches. The PINCER intervention group (n=36) was given similar information, but in addition, pharmacist support was assigned to work with practices on indicators and practical support to tackle recognised prescribing safety issues. The trial demonstrated at six-month follow-up hazardous prescribing was significantly lower in the PINCER group and that the intervention was likely to be cost-effective.
What has been the clinical impact of PINCER?
- PINCER is supported by current NICE Guidelines on Medicines Optimisation (NICE 2015).
- PINCER is a key part of the RCGP patient safety toolkit, designed to be used by GP practices in the UK.
- PINCER was implemented and evaluated in 370 practices across the east Midlands (12 CCGs) between Sept 2015 and Apr 2017:
- 21,617 cases of hazardous prescribing identified
- Statistically significant reductions in hazardous prescribing
- Over 10,500 patients received an active intervention to make their medication safer
- Since 2013 the PINCER Tool has been accessed by more than 2,400 practices.