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Pharmacist-led intervention reduced medical errors in general practices
Avery A. Lancet. 2012;doi:10.1016/S0140-6736(11)61817-5.
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Using a pharmacist-led information technology intervention for medication errors reduced a range of medical errors in general practices that have computerized clinical records, according to researchers in the United Kingdom.
“Although important progress has been made in the implementation of interventions for use in specialist care settings, particularly in relation to computerized entry of physician orders and computerized decision support, the evidence for primary care — in which most patients are now managed worldwide — is still very weak,” the researchers wrote.
For the two-group, pragmatic, cluster-randomized trial, eligible practices were stratified by center and list size. They were randomly allocated to receive the intervention or control by block randomization, with block sizes of two or four. The control group included computer-generated simple feedback for at-risk patients, and the intervention group included pharmacist-led information technology intervention (PINCER), which included feedback, educational outreach and dedicated support. The study included 72 general practices with 480,942 patients.
Primary outcome measure was the proportion of patients who had any of the following 6 months after the intervention: prescription of a nonselective nonsteroidal anti-inflammatory drug to patients with a peptic ulcer without a prescription of a proton pump inhibitor; prescription of a beta-blocker to those with a history of asthma; or prescription of an angiotensin-converting enzyme (ACE) inhibitor or loop diuretics to patients aged 75 years or older, without assessment of urea and electrolytes in the preceding 15 months.
At 6 months’ follow-up, patients in the PINCER group were less likely to have been prescribed a nonselective NSAID without gastroprotection if they had a history of peptic ulcer (OR=0.58, 95% CI, 0.38-0.89); less likely to have been prescribed with a beta-blocker if they had asthma (OR=0.73, 95% CI, 0.58-0.91); and less likely to have been prescribed an ACE inhibitor or loop diuretic without appropriate monitoring (OR=0.51; 95% CI, 0.34-0.78).
“The intervention that we have developed will be suitable for implementation in the increasing number of countries where clinical records are now computerized, and where the roles of pharmacists to monitor proactively for clinically important medication errors can be extended,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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