Morris CJ et al. 2006 "Preventing drug related morbidity: a process for facilitating changes in practice."
Reference
Morris CJ, Cantrill JA, Avery AJ, et al. Preventing drug related morbidity: a process for facilitating changes in practice. Qual Saf Health Care 2006;15(2):116-121.
Abstract
"Aim: To describe how quantitative data obtained from applying a series of indicators for preventable drug related morbidity (PDRM) in the electronic patient record in English general practice can be used to facilitate changes aimed at helping to improve medicines management.
Design: A multidisciplinary discussion forum held at each practice facilitated by a clinical researcher.
Subjects and setting: Eight English general practices.
Outcome measures: Issues discussed at the multidisciplinary discussion forum and ideas generated by practices for tackling these issues. Progress made by practices after 1, 3, and 6 months.
Results: A number of clinical issues were raised by the practices and ideas for moving them forward were discussed. The issues that were easiest and most straightforward to deal with (for example, reviewing specific patient groups) were quickly addressed in most instances. Practices were less likely to have taken steps towards addressing issues at a systems level.
Conclusions: Data generated from applying PDRM indicators can be used to facilitate practice-wide discussion on medicines management. Different practices place different priority levels on the issues they wish to pursue. Individual practice "ownership" of these, together with having a central committed figure at the practice, is key to the success of the process."
Design: A multidisciplinary discussion forum held at each practice facilitated by a clinical researcher.
Subjects and setting: Eight English general practices.
Outcome measures: Issues discussed at the multidisciplinary discussion forum and ideas generated by practices for tackling these issues. Progress made by practices after 1, 3, and 6 months.
Results: A number of clinical issues were raised by the practices and ideas for moving them forward were discussed. The issues that were easiest and most straightforward to deal with (for example, reviewing specific patient groups) were quickly addressed in most instances. Practices were less likely to have taken steps towards addressing issues at a systems level.
Conclusions: Data generated from applying PDRM indicators can be used to facilitate practice-wide discussion on medicines management. Different practices place different priority levels on the issues they wish to pursue. Individual practice "ownership" of these, together with having a central committed figure at the practice, is key to the success of the process."
Objective
"To describe how quantitative data obtained from applying a series of indicators for preventable drug-related morbidity (PDRM) in the electronic patient record in English general practice can be used to facilitate changes aimed at helping to improve medicines management."
Tools Used
Type Clinic
Primary care
Size
Small and/or medium
Geography
Urban and suburban
Type of Health IT
EHR application search functionality
Type of Health IT Functions
"The program conducts a retrospective anonymised review of electronic patient records to identify the number of [preventable drug related morbidity (PDRM)] events in patients over the age of 18." One example of a PDRM event is when a patient has a second myocardial infarction after the physician failed to prescribe aspirin when aspirin was not contraindicated. The program searched for 20 types of potential PDRMs.
Context or other IT in place
Electronic health records (EHR)
Workflow-Related Findings
Six months after the facilitated discussion, the level of progress on identified issues varied. Most practices "reviewed specific patient groups - for example, asthmatic patients prescribed b blockers - ... often within the first month.... [O]ne practice had set up a template on their computer system for annual monitoring of the full blood count for patients prescribed carbamazepine within 3 months, [but] another was still in the process of defining the level of monitoring for angiotensin converting enzyme inhibitors at the 6 month follow up."
Issues that were identified included (1) "[f]ollow up of patients not prescribed aspirin or a beta blocker after MI" (three practices), (2) "[f]ollow up of all asthmatic patients prescribed oral beta blockers" (two practices), (3) "[r]eviewing blood results of patients prescribed carbamazepine" (one practice), (4) "[a]ddressing the uncertainty relating to INR results when issuing warfarin on repeat prescription" (three practices), (5) "[r]eviewing the use of spacers with patients prescribed high dose metered dose inhaled steroids" (two practices), and (6) "[a]udit of monitoring of urea and electrolytes of patients prescribed ACE inhibitors in the last 12 months" (three practices).
For some issues, the practice staff identified potential ways of addressing the PDRM, such as having the pharmacist make sure the section of the electronic ischaemic heart disease template on contraindications was filled in, so that it is clear whether a post-MI patient should be prescribed aspirin or a beta blocker.
"Most [general practitioners] felt they had benefited from their involvement as it had encouraged them to view some specific issues in a systematic way and increased their awareness of what they were and were not currently doing."
Study Design
Only postintervention (no control group)
Study Participants
A total of eight practices participated in this study. The recruited clinics were contained under three primary care trusts (combinations of "primary care and community care services in a single organisation.") Two were from the East Midlands and one was from northwest England. The practices agreed to let the research team search for specific types of preventable drug related morbidity (PDRM) events in their electronic health records and to participate in a multidisciplinary discussion of the PDRM events found, with an aim to identify the root causes of the events. Participants in the discussions included "general practitioners, at least one representative from the nursing staff, the practice/[primary care trust] PCT pharmacist, and the practice manager."