Repeat prescribing of medications: a system-centred risk management model for primary care organisations

Price, J., Man, S. L., Bartlett, S., Taylor, K., Dinwoodie, M. and Bowie, P. (2017) Repeat prescribing of medications: a system-centred risk management model for primary care organisations. Journal of Evaluation in Clinical Practice, 23(4), pp. 779-796. (doi: 10.1111/jep.12718) (PMID:28370904)

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Abstract

Rationale, aims and objectives: Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care. Methods: All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses. Results: Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0). Conclusions: The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally.

Item Type:Articles
Keywords:Information technology, medication safety, patient safety, primary care, risk management.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Bowie, Dr Paul
Authors: Price, J., Man, S. L., Bartlett, S., Taylor, K., Dinwoodie, M., and Bowie, P.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
Journal Name:Journal of Evaluation in Clinical Practice
Publisher:Wiley
ISSN:1356-1294
ISSN (Online):1365-2753
Published Online:31 March 2017
Copyright Holders:Copyright © 2017 The Authors
First Published:First published in Journal of Evaluation in Clinical Practice 23(4): 779-796
Publisher Policy:Reproduced under a Creative Commons license

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