Hospital prescribing plan cuts mortality 16% and could be template for GPs

Prescribing quality improvements that cut mortality by over 16% in a UK hospital study could provide a template for GPs to improve prescribing quality, a leading GP believes.

Prescribing: improvements cut hospital mortality
Prescribing: improvements cut hospital mortality

Dr Jamie Coleman and colleagues evaluated a prescribing quality improvement programme introduced at University Hospitals Birmingham NHS Foundation Trust. The researchers said the strategy was based on a ‘trust-wide drive to reduce errors to a minimum’.

‘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,' they said.

Alongside the recording of missed doses of antibiotics, the trust introduced a string of measures to improve the quality of prescribing. This included advanced decision support for prescribers, ward-based dashboards and meetings to discuss care omissions.

Over the period in which these measures were introduced, there was a 16.2% fall in mortality across the trust. 

Moving-average mortality fell from 5.44% between April 2007 and March 2008 to 4.56% 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 led to ‘an institution-wide cultural and behavioural change in attitude to errors previously perceived as unimportant’.

Wirral GP Dr James Kingsland, the DH’s clinical commissioning network lead for England, told GP magazine that GP practices could learn from the Birmingham research.

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

Dr Kingsland said 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’.

He said the way that the NHS would achieve its £20bn efficiency target would also be similar to the Birmingham programme's approach.

‘We’re going to make the productivity changes by reducing waste and improving efficiency,’ he said. ‘We have inefficiency in terms of duplication of services, in terms of waste, and it’s by reducing that inefficiency that we’ll meet Nicholson challenge.’

He said that commissioners did not need to direct individual changes in practice, as it would be down to providers to decide how those outcomes were achieved.

‘Commissioners should be saying that providers should be reducing mortality, but I don’t think we should be micro-managing how that is done,’ he said.

'Providers should be able to find the evidence as much as commissioners can,' he added.

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