Prescribing safely with PRIMIS
Portsmouth 2009
As patient safety continues to drive the work done by PRIMIS, the service has been delighted by the uptake of the Safer Prescribing query set released in July 2009.
This CHART query library enables practices to examine their current prescribing to identify issues or even systems which might need attention.
Taking into account a patient's past medical history, concurrent medications, laboratory tests and age, the queries have been designed to highlight any potential prescribing errors.
Facilitators at Portsmouth PCT were among the first to implement the queries, during a local pilot scheme designed to encourage practices to utilise audits to review patient safety issues and help improve data quality.
Primary Care Improvement & Development Manager Steve McInnes explained that after volunteering for the pilot, six practices were given assistance to run the queries and create reports. Steve could then help to analyse the results during a feedback session with GPs and practice managers.
Practice staff were then asked to provide feedback on how useful the query set was, any issues that arose and the proportion of patients who may have been prescribed the wrong medication.
Obstacles to success
As well as an outbreak of swine flu, when running the pilot Steve has come up against time constraints both in practices and in his own schedule.
However, Steve explained: "I have been careful not to put too much pressure on practices, but explained that the work can be done at a time that suits them. To reduce the impact further I encouraged clinicians to share the extra workload and I made myself available to assist the practices with the initial ground work".
"While the pilot also impacted on my other work, the Head of Primary Care here at Portsmouth PCT is fully behind the project work as is the Medicines Management team, so I feel supported and justified in allocating some time to this."
He continued: "I will now ensure that the pilot is not just a one-off exercise purely about running the queries, but that we learn from it, share information, analyse the systems and processes currently in place and look at the wider picture by linking in with other projects."
Hard work pays off
If this work does continue, Steve believes that it will have major benefits for practices and their patients by establishing whether the policies and protocols in place are satisfactoy and if system alerts are adequate. It will also highlight any training issues and give practices some reassurance.
Steve continued: "With more importance being given to the recording of important clinical information, this project should improve data quality in general and provide focus when reporting incidents and monitoring significant events. Increased patient safety is the ultimate aim!"
After running the pilot project, Steve now appreciates how many ways patient safety can potentially be compromised through inappropriate prescribing or inadequate systems.
He concluded: "It is clear that the Safer Prescribing query set is a very useful tool to help practices review potential issues. But this should not be used in isolation, we need to look at the wider picture as well.
"We must also recognise that the results from the PRIMIS queries should not be taken at face value, as in the majority of cases it appears that the clinicians have taken well-informed decisions based on the knowledge of their patients. Nonetheless the practices have felt the review of the data was very worthwhile and at times has actually been reassuring."
He continued: "Ensuring that a joined-up approach is taken is vital, i.e. linking with other PCT staff including the medicines management team and QOF assessors and looking to share relevant outcomes or issues with all practices where possible." |
