Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study

Tudor Car, Lorainne; Papachristou, Nikolaos; Gallagher, Joseph; Samra, Rajvinder; Wazny, Kerri; El-Khatib, Mona; Bull, Adrian; Majeed, Azeem; Aylin, Paul; Atun, Rifat; Rudan, Igor; Car, Josip; Bell, Helen; Vincent, Charles and Dean Franklin, Bryony (2016). Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study. BMC Family Practice, 17(160)

DOI: https://doi.org/10.1186/s12875-016-0552-6

Abstract

Background Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care.

Methods We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014.

Results The top three problems were incomplete reconciliation of medication during patient ‘hand-overs’, inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score.

Conclusions Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.

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About

• Item ORO ID
• 47950
• Item Type
• Journal Item
• ISSN
• 1471-2296
• Project Funding Details

• Funded Project Name	Project ID	Funding Body
  Not Set	Not Set	Imperial College Health Partners
  Not Set	Not Set	National Institute for Heath Research (NIHR)

• Keywords
• Medication error; Patient safety; Priority-setting; Crowd-sourcing; Primary care; Clinicians
• Academic Unit or School
• Faculty of Wellbeing, Education and Language Studies (WELS) > Health, Wellbeing and Social Care > Health and Social Care
  Faculty of Wellbeing, Education and Language Studies (WELS) > Health, Wellbeing and Social Care
  Faculty of Wellbeing, Education and Language Studies (WELS)
• Research Group
• ?? hwpra ??
• Copyright Holders
• © 2016 The Authors
• Depositing User
• Rajvinder Samra