title: Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method.
abstract: BACKGROUND
  In 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.
  
  
  OBJECTIVE
  To identify a set of potential prescribing-safety indicators for the purposes of revalidation of individual GPs in the UK.
  
  
  METHODS
  The RAND Appropriateness Method was used to identify, develop, and obtain agreement on the indicators in UK general practice.
  
  
  METHODS
  Twelve GPs from across the UK with a wide variety of characteristics assessed indicators for appropriateness of use in revalidation.
  
  
  RESULTS
  Forty-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 drug-drug combinations, prescribing with a history of allergy, and inadequate laboratory-test monitoring.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: School of Community Health Sciences, University of Nottingham, Nottingham, UK. tony.avery@nottingham.ac.uk
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Avery
authors.forename: Grant M
authors.initials: GM
authors.lastname: Dex
authors.forename: Caroline
authors.initials: C
authors.lastname: Mulvaney
authors.forename: Brian
authors.initials: B
authors.lastname: Serumaga
authors.forename: Rachel
authors.initials: R
authors.lastname: Spencer
authors.forename: Helen E
authors.initials: HE
authors.lastname: Lester
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Campbell
mesh_terms: D000068:Accreditation; D011307:Drug Prescriptions / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D004364:Pharmaceutical Preparations / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D017751:Safety Management; D006113:United Kingdom
chemical_list: D004364:Pharmaceutical Preparations