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All this prescribing errors tech is giving me alert fatigue

By Dr Livingstone
GP blogger

11 Jul 2019

The expansion of a pharmacist-led prescribing intervention means more scrutiny and interference, writes our GP blogger Dr Livingstone.

One thing I think we can all agree on is that the pharmacist-led initiative to reduce medication errors, known as ‘PINCER’, must be one of the most contrived acronyms ever. It apparently stands for ‘Pharmacist led information technology intervention reducing clinically important errors’ (I’m guessing a bit with those letters). To you and me, that’s actually ‘PLITIRCIE’.

Whatever. You’d think we’d also agree that, regardless of acronyms, rolling it out nationally to general practice – as the NHS Patient Safety Strategy has suggested – is a great idea. After all, it apparently reduces prescribing errors by 50%, so what’s not to like?

Specifically, this: currently, on Planet GP, we are feeling over-scrutinised and micromanaged. This is particularly true in the area of therapeutics. Though some of you will find it hard to believe, I did study pharmacology at medical school. And armed with this knowledge, some experience, and my trusty BNF, I reckon I have enough checks and balances on board to keep my prescribing safe.

Apparently not. So, in addition, I have software alerts popping up about interactions and side effects whenever I try to prescribe. Warnings about patients on DMARDs each time I open their records. A prescribing incentive scheme coercing me into audits and reviews. A software monitoring system that systematically searches for any prescribing issues on a monthly basis. A revised QOF section focusing on prescribing safety. And so on.

Two things happen when you feel overloaded by scrutiny and interference. One is that you develop an alert fatigue which means you may end up ignoring something really important, simply because you cannot see the signal for the noise. And the other is that you worry about opportunity cost: what, in my day job, am I having to ignore or neglect given that I’m being forced to constantly obsess about prescribing?

So PINCER may be a lousy name. But, given the painful pinch on my time and my psyche, it’s just about perfect.

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