Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method

Abstract

BackgroundIn the UK, a process of revalidation is being introduced to allow doctors to demonstrate that they meet current professional standards, are up-to-date, and fit to practise. Given the serious risks to patients from hazardous use of medicines it will be appropriate, as part of the revalidation process, to assess the safety of prescribing by GPs. AimTo identify a set of potential prescribing-safety indicators for the purposes of revalidation of individual GPs in the UK. Design and settingThe RAND Appropriateness Method was used to identify, develop, and obtain agreement on the indicators in UK general practice. MethodTwelve GPs from across the UK with a wide variety of characteristics assessed indicators for appropriateness of use in revalidation. ResultsForty-seven safety indicators were considered appropriate for assessing the prescribing safety of individual GPs for the purposes of revalidation (appropriateness was defined as an overall panel median score of ≥7 (on a 1-9 scale), with no more than three panel members rating the indicator outside the 3-point distribution around the median]. After removing indicators that were variations on the same theme, a final set of 34 indicators was obtained; these cover hazardous prescribing across a range of therapeutic areas, hazardous drugdrug combinations, prescribing with a history of allergy, and inadequate laboratory-test monitoring. ConclusionThis study identified a set of 34 indicators that were considered, by a panel of 12 GPs, to be appropriate for use in assessing the safety of GP prescribing for the purposes of revalidation. Violation of any of the 34 indicators indicates a potential patient-safety problem.

Patient safety in primary health care: a systematic review

“…There was a balance in the yearly distribution of the articles' publication: four in 2007 9,10,11,12 , six in 2008 13,14,15,16,17,18 , three in 2009 19,20,21 , ten in 2010 22,23,24,25,26,27,28,29,30,31 , six in 2011 32,33,34,35,36,37 and four in 2012 38,39,40,41 (Table 2).…”

“…The study population consisted of physicians and other health professionals 9,10,13,14,15,16,19,20,22,24,25,28,30,32,33,34,35,36,39,40 , patients and families 26 , and health professionals and patients and families 11,21,23,27,29,31,41 , while in some studies the study population was not described in complete detail 17,22,38 (Table 2).…”

“…All the studies were descriptive. Nine studies were retrospective 9,13,14,15,18,19,32,37,38 , 14 prospective 10,16,20,22, 23,24,25,26,27,28,33,34,39,40 , and ten cross-sectional 11,12,17,21,29,30,31,35,36,41 .…”

“…Questionnaires were also used by some authors to extract data, and were answered by physicians 22,40 , physicians and other health professionals 10,16,28,34 , or patients and family members 26,27 . Other studies used a combination of methods for data sources: incident reporting systems, direct observation, and focus groups 35 ; incident reporting systems, direct observation, and interviews 11 ; direct observation with audio recording 29 ; direct observation and expert consensus 36 ; incident reporting systems, patient file review, and interviews 41 ; incident reporting systems and patient file review 21 ; incident reporting systems, interviews, and questionnaires 30 ; expert consensus, questionnaires for patients, and focus groups 31 ; incident reporting systems, patient file review, and questionnaires 41 (Table 2). Six studies 12,17,21,30,31,41 used a combination of data sources.…”

Digoxin doses over 125μg daily in vulnerable patient groups

“…1 The evidence base behind each of the indicators is given along with information to illustrate their clinical significance. We provide a 'real-life' audit based on the indicator to show how practices could begin to analyse their own prescribing data.…”