Hospital prescribing model could help GPs

IMPROVEMENTS in prescribing that cut mortality at a UK hospital by more than 16 per cent could be applied in general practice, according to a leading GP.

A prescribing quality improvement programme that aimed to reduce errors in care delivery was introduced at University Hospitals Birmingham NHS Foundation Trust. An evaluation led by Dr Jamie Coleman found the scheme had been successful even though many of the errors avoided were minor.

Researchers said the underpinning hypothesis is that “reducing errors in care delivery will improve outcomes, even if the individual errors themselves may not be judged as significant.”

Under the programme a series of measures were implemented including the recording of missed doses of antibiotics, advanced decision support for prescribers, ward-based dashboards and meetings to discuss care omissions. This led to a 16.2 per cent drop in mortality across the trust.

Moving-average mortality fell from 5.44 per cent between April 2007 and March 2008 to 4.56 per cent between March 2010 and February 2011. This fall in mortality was not found in national mortality rates in the rest of England, which remained unchanged.

The researchers said they believed the programme had inspired “an institution-wide cultural and behavioural change in attitude to errors previously perceived as unimportant.”

Dr James Kingsland, a GP and the Department of Health’s clinical commissioning network lead for England, told GP magazine the programme could be effective in general practice.

He said: “There are a whole range of issues to do with quality of prescribing in primary care. There's a whole range of discussions we can have around polypharmacy, antibiotic prescribing and antipsychotics.”

He added that improvements across primary and secondary care would come from “making those smaller changes in a daily practice across the whole organisation, and doing it at scale.”

Read the study at http://shortreports.rsmjournals.com/content/3/6/36.short