Abstract
Rationale, aims and objectivesReducing 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.MethodsAll 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.ResultsAcross 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).ConclusionsThe 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.
Highlights
Preventable harm from medication‐related incidents, including those involving “repeat prescriptions,” is a significant source of concern in primary care settings worldwide.[1,2] On a daily basis in the United Kingdom, for example, over 1 million patients consult with a primary care clinician and around 2.3 million medication items are prescribed.[3]
Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions, equating to a mean of 8.1 risks per practice
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
Summary
Preventable harm from medication‐related incidents, including those involving “repeat prescriptions,” is a significant source of concern in primary care settings worldwide.[1,2] On a daily basis in the United Kingdom, for example, over 1 million patients consult with a primary care clinician and around 2.3 million medication items are prescribed.[3]. “Repeat prescriptions” refers to prescribed medication items that patients receive for long‐term use, normally without the need for regular or extensive monitoring or review by clinical consultation.[6] The benefits include increased convenience for patients and reduced workloads for practices. Over the past 20 years, it is estimated that the number of repeat prescription items issued has doubled from 5.8 to 13.3 items per patient per annum.[4] While this impacts significantly on the annual NHS budget, it has implications for the complex management of related clinical risks, levels of avoidable patient harm, increased workloads, organisation of work in general practice, and patient experience of healthcare provision.[5,6]
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