The effectiveness of structured medication reviews to reduce prescribing errors within a GP setting.

Dr Lauren McTaggart

Background and Aims:

The effectiveness of comprehensive medication reviews within the primary care setting is directly correlated with enhanced patient safety and improved clinical outcomes (1, 2). Structured medication reviews involve a thorough review of a patient’s medication and take into consideration all aspects of health, whilst weighing up risks vs benefits. Prescribing initially occurs in the primary care setting and therefore timely review of medications will reduce adverse side effects and ultimately reduce hospital admissions.

• The primary aim was to reduce medication errors for patients at risk of harm in a single GP surgery over 4 months by performing structured medication reviews.

• The secondary aim was to provide recommendations for safe drug prescribing and monitoring.

Methods:

• A computer programmed search (SystemOne) was conducted on the electronic patient notes to identify patients at risk of harm.

• The definition of ‘patients at risk of harm’ was set out by Arden's (3) .

• A total of 107 patients were included.

• Patients receiving end of life care were excluded from the search.

• Data was collected over a 4 month period.

• PDSA methodology was used.

Plan

• Understand scope of issue.

• Aims and interventions discussed.

• Initial computer search run to identify patients at risk of harm due to medication errors.

Results:

Do

•

Patients defined as at risk of harm due to medication errors:

• ≥ 65: NSAID and no gastroprotective.

• ≥ 18: history of peptic ulceration and NSAID.

• ≥ 18: history of peptic ulceration and anti-platelet.

• ≥ 18: anticoagulant and NSAID within 28 days of each other.

• ≥ 18: anticoagulant and anti-platelet within 28 days of each other.

• ≥ 18: aspirin and another type of anti-platelet within 28 days of each other.

• ≥ 18: history of unresolved heart failure diagnosis and NSAID.

• ≥ 18: eGFR of less than 45ml per minute and NSAID .

• ≥ 18: unresolved asthma diagnosis and non-selective beta-blocker.

Study

Data analysed using the following parameters:

• Number of medication errors

• Specific medication error

•

•

SMR complete > Computer Search Re-run = 80% reduction in patients at risk of harm due to medication errors within a single GP surgery over 4 months.

Recommendations:

• Medication reviews should be performed early.

• Annual review of bloods should be performed in patients at risk of harm.

• Caution should be taken when prescribing an aspirin and anti-platelet together.

• Risk assessments should be performed to determine whether gastroprotection is required.

• Specialist input, patient history and patient choice play a crucial role in determining medication regimes.

• Date of medication error

• Date rectified

• Intervention

Act

Computer search re-run:

• 80% reduction in patients at risk of harm due to medication errors.

• Recommendations made to the practice healthcare and prescribing teams.

• Plan for further PDSA cycles.

Structured Medication Reviews revealed:

• 17% of patients defined as at risk of harm had more than one medication error.

• The most common specific medication error was those who were prescribed both an aspirin and another type of anti-platelet within 28 days of each other.

• The most common intervention following the SMR was no intervention (Figure 1.).

• The reasons for no intervention are shown in figure 2.

Learning Points:

• A comprehensive structured medication review by healthcare professionals can reduce the number of patients at risk of harm due to medication errors.

• The specific type of intervention should be tailored to each patient depending on patient choice, clinical history and also specialist medical input.

• Structured medication reviews are a sustainable, quick and effective method within the GP setting to reduce adverse side effects, enhance patient safety and improve clinical outcomes

Dr L. Foglizzo, Dr D. Ramsay Woodend Hospital, Aberdeen