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Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

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Garfield, Sara, Barber, Nick, Walley, Paul, Willson, Alan and Eliasson, Lina. (2009) Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature. BMC Medicine, Vol.7 (Articl). ISSN 1741-7015

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Official URL: http://dx.doi.org/10.1186/1741-7015-7-50

Abstract

Background: The UK, USA and the World Health Organization have identified improved patient safety in healthcare as a priority. Medication error has been identified as one of the most frequent forms of medical error and is associated with significant medical harm. Errors are the result of the systems that produce them. In industrial settings, a range of systematic techniques have been designed to reduce error and waste. The first stage of these processes is to map out the whole system and its reliability at each stage. However, to date, studies of medication error and solutions have concentrated on individual parts of the whole system. In this paper we wished to conduct a systematic review of the literature, in order to map out the medication system with its associated errors and failures in quality, to assess the strength of the evidence and to use approaches from quality management to identify ways in which the system could be made safer. Methods: We mapped out the medicines management system in primary care in the UK. We conducted a systematic literature review in order to refine our map of the system and to establish the quality of the research and reliability of the system. Results: The map demonstrated that the proportion of errors in the management system for medicines in primary care is very high. Several stages of the process had error rates of 50% or more: repeat prescribing reviews, interface prescribing and communication and patient adherence. When including the efficacy of the medicine in the system, the available evidence suggested that only between 4% and 21% of patients achieved the optimum benefit from their medication. Whilst there were some limitations in the evidence base, including the error rate measurement and the sampling strategies employed, there was sufficient information to indicate the ways in which the system could be improved, using management approaches. The first step to improving the overall quality would be routine monitoring of adherence, clinical effectiveness and hospital admissions. Conclusion: By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Social Sciences > Warwick Business School
Library of Congress Subject Headings (LCSH):	World Health Organization, Medication errors -- Research, Primary care (Medicine) -- Great Britain, Quality control -- Great Britain
Journal or Publication Title:	BMC Medicine
Publisher:	BioMed Central Ltd.
ISSN:	1741-7015
Date:	21 September 2009
Volume:	Vol.7
Number:	Articl
Identification Number:	10.1186/1741-7015-7-50
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	Wales. National Leadership and Innovation Agency for Healthcare (NLIAH)
References:	1. Department of Health: An organisation with a memory. Report of an expert group on learning from adverse events in the NHS London: The Stationery Office; 2000. 2. Department of Health: Building a safer NHS for patients: improving medication safety. A report by the Chief Pharmaceutical Officer London: The Stationery Office; 2004. 3. Institute of Medicine: To err is human: Building a safer health system. Report of the Committee on Quality of Healthcare in America Washington: National Academy Press; 2000. 4. World Health Organization: Quality of care: patient safety. Report by the Secretariat Geneva: World Health Organization; 2002. 5. Department of Health: Pharmacy in England. Building on strengths-delivering the future London: The Stationary Office; 2008. 6. Department of Health: Design for safety. A system-wide design-led approach to tackling patient safety in the NHS London: Department of Health; 2003. 7. National Institute of Clinical Excellence: Technical patient safety solutions for medicines reconciliation on admission of adults to hospital: Guidance London: NICE; 2007. 8. Institute of Healthcare Improvement: Getting started kit: Prevent adverse drug events (medication reconciliation). How-to guide Massachusetts: Institute of Healthcare Improvement; 2007. 9. Royal S, Smeaton L, Avery AJ, Hurwitz B, Sheikh A: Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Safe Health Care 2006, 15:23-31. 10. Spear S: Fixing healthcare from the inside. Harvard Business Rev 2005, 83:78-91. 11. Berwick DM, Godfrey AB, Roessner J: Ten key lessons for quality improvement during healthcare. In New strategies for Quality improvement San Francisco: Jossey-bass; 1990:157. 12. Proudlove N, Moxham C, Boaden R: Lessons for Lean in Healthcare from Using Six Sigma in the NHS . Public Money Management 2008, 28(1):27-34. 13. Taner MT, Sezen B, Antony J: An overview of six sigma applications in healthcare industry. Int J Health Care Qual Assur 2007, 20:329-340. 14. Esimai : Lean Six Sigma reduces medication errors. Quality Progress 2005, 38:51-57. 15. Al-Shaqha WMS, Zairi M: Reengineering pharmaceutical care: towards a patient-focused care approach. Int J Health Care Qual Assur 2000, 13:208-217. 16. Franklin BD, O'Grady K, Paschalides C, Uley M, Gallavin S, Jacklin A, Barber N: Providing feedback to hospital doctors about prescribing errors: a pilot study. Pharm World Sci 2007, 29:213-220. 17. Rother M, Shook J: Learning to see: value-stream mapping to create value and eliminate muda Massachusetts: The Lean Enterprise Institution; 2003. 18. National Collaborating Centre for Primary Care: Medicines adherence Involving patients in decisions about prescribed medicines and supporting adherence London National Institute for Health and Clinical Excellence; 2009. 19. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X: Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008:CD000011. 20. Bicheno J: The New Lean Toolbox Buckingham: PICSIE Books; 2004. 21. Shah SNH, Aslam M, Avery AJ: A survey of prescription errors in general practice. Pharmaceutical J 2001, 267:860-862. 22. Jones I, Britten N: Why do some patients not cash their prescriptions? Br J Gen Pract 1998, 48:903-905. 23. Beardon PHG, McGilchrist MM, McKendrick AD, McDevitt DG, Mac- Donald TM: Primary non-compliance with prescribed medication in primary care. Br Med J 1993, 307:846-848. 24. Dean Franklin B, O'Grady K: Dispensing errors in community pharmacy: frequency, clinical significance and potential impact of authentication at the point of dispensing. Int J Pharmacy Practice 2007, 15:273-281. 25. Howard RL, Avery AJ, Howard PD, Partridge M: Investigation into the reasons for preventable drug related admissions to a medical admissions unit: observational study. Qual Safe Health Care 2003, 12:280-285. 26. Pirohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM: Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. Br Med J 2004, 329:15-19. 27. Green CF, Mottram DR, Rowe PH, Pirmohamed M: Adverse drug reactions as a cause of admission to an acute medical unit: a pilot study. J Clin Pharm Ther 25:355-361. 28. Zermansky AG: Who controls repeats. Br J Gen Pract 1996, 46:643-647. 29. Jani YH, Ghaleb MA, Marks SD, Cope J, Barber N, Wong ICK: Electronic prescribing reduced prescribing errors in a pediatric renal outpatient clinic. J Pediat 2008, 152:214-218. 30. Collins DJ, Nickless GD, Green CF: Medication histories; does anyone know what medicines a patient should be taking? Int J Pharmacy Practice 2004, 12:173-178. 31. Hippisley-Cox JH, Pringle M, Cater R, Wynn A, Hammersley V, Coupland C, Hapgood R, Horsfield P, Teasdale S, Johnson C: The electronic patient record in primary care- regression or progression? A cross sectional study. Br Med J 2003, 236:1439-1443. 32. Manday A, Kelly B, Forrester JWE, Timoney A, McGovern E: Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care? Br J Gen Pract 1997, 47:563-566. 33. Brookes K, Scott MG, McConnell JB: The benefits of a hospital based community services liason pharmacy. Pharm World Sci 2000, 22:33-38. 34. Ahmed S, Harding J: Investigating the procedures, drawbacks and implications of seamless primary-secondary care. Quality in Primary Care 2005, 12:51-55. 35. Rees S, Thomas P, Shetty A, Makinde K: Drug history errors in the acute medical assessment unit quantified by the use of the NPSA classification. Pharmaceutical J 2007, 279:469-471. 36. Pickrell L, Duggan C, Dhillon S: From hospital admission to discharge: an exploratory study to evaluate seamless care. Pharmaceutical J 2001, 267:650-653. 37. Morcos S, Francis S-A, Duggan C: Where are the weakest links? A descriptive study of discrepancies in prescribing between primary and secondary sectors of mental health service provision. Psychiatric Bull 2002, 26:371-374. 38. Sagripanti M, Dean B, Barber N: An evaluation of the processrelated medication risks for elective surgery patients from pre-operative assessment to discharge. Int J Pharmacy Practice 2002, 10:161-170. 39. Franklin BD, O'Grady K, Donyai P, Jacklin A, Barber N: The impact of a closed-loop prescribing and administration system on prescribing errors, administration errors and staff time. Qual Safe Health Care 2007, 16:279-284. 40. Donyai P, O'Grady K, Jacklin A, Barber N, Franklin BD: The effects of electronic prescribing on the quality of prescribing. Br J Clin Pharmacol 2007, 65:230-237. 41. Barber N, Franklin BD, Cornford T, Klecun E, Savage I: Safer, faster, better? Evaluating electronic prescribing. Report to the Patient Safety Research Programme London: The Department of Health; 2006. 42. Tully MP, Parker D, Buchan I, McElduff P, Heathfield H, Rogers J, Healthfield s, Latif S, Smith G, Eden M, Malik H, Cantrill J: Patient Safety Research Programme Medication Errors 2: Pilot Study Volume 16. London: The Department of Health; 2007:40-44. 43. Gethins B: Wise up to medication errors. Pharmacy in Practice 1996, 6:323-328. 44. Olsen S, Neale G, Schwab K, Psalia B, Patel T, Chapman EJ, Vincent C: Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time review may all have a place. Qual Safe Health Care 2007, 16:40-44. 45. Duggan C, Bates I, Hough J: Discrepancies in prescribing. Where do they occur? Pharmaceutical J 1996, 256:65-67. 46. Duggan C, Feldman R, Hough J, Bates I: Reducing adverse prescribing discrepancies following hospital discharge. Int J Pharmacy Practice 1998, 6:77-82. 47. Smith L, McGowan L, Moss-Barclay C, Wheater J, Knass D, Chrystyn H: An investigation of hospital generated pharmaceutical care when patients are discharged from hospital. Br J Clin Pharmacol 1997, 44:163-165. 48. Hassey A, Gerrett D, Wilson A: A survey of validity and utility of electronic patient records in a general practice. Br Med J 2001, 322:1401-1405. 49. Jordon K, Porcheret M, Croft P: Quality of morbidity coding in general practice computerized medical records: a systematic review. Fam Pract 2004, 21:396-412. 50. Natarajan R: Transferring best practices to healthcare: opportunities and challenges. TQM Magazine 2006, 18:572-582. 51. Slack N, Chambers S, Johnston R, Betts A: Operations and Process Management New Jersey: Prentice Hall; 2006. 52. Benneyan JC, Lloyd RC, Plsek PE: Statistical process control as a tool for research and healthcare improvement. Qual Safe Health Care 2003, 12:458-464.
URI:	http://wrap.warwick.ac.uk/id/eprint/2158