CLINICIAN-IDENTIFIED PRIORITIES FOR MEDICATION SAFETY IN PRIMARY CARE: A PRIORITIZE STUDY
Medication errors are one of the most commonly reported patient safety incidents in primary care. To determine priorities for prevention of medication errors in primary care according to clinicians, we developed and implemented a novel priority-setting method called PRIORITIZE.
We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to medication errors in primary care. 113 clinicians submitted their suggestions which were thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A random group of 57 clinicians scored these and an overall ranking was derived.
The top three threats to medication safety were incomplete reconciliation of medication during patient ‘hand-overs’, inappropriate patient education and poor discharge summaries. The top three solutions to medication safety threats were the development of a standardized discharge summary template, reduction of unnecessary prescribing and minimization of polypharmacy.
Overall, poor communication between different care providers, inadequate quality control during the prescription and monitoring stage and patient-related factors (e.g. polypharmacy or memory issues) were identified as the main safety concerns. Proposed solutions focused on electronic and procedural interventions for improving care integration, quality control during the prescribing and monitoring stage and patient empowerment with better guidelines or information material.
The central finding is that, according to clinicians, medication errors can be prevented with relatively minor investment. The PRIORITIZE approach allows policymakers to trigger staff involvement, gather their feedback on patient safety priorities and ultimately align policies with the collated information. This approach is complementary to current patient safety exploration tools used for mapping of primary care safety priorities. We propose exploring whether it could be embedded into the annual appraisal of staff to detect any vulnerabilities at different levels of care.