title: Repeat prescribing of medications: A system-centred risk management model for primary care organisations.
abstract: OBJECTIVE
  Reducing preventable harm from repeat medication prescriptions is a patient safety priority worldwide. In the United Kingdom, repeat prescriptions items issued has doubled in the last 20 years from 5.8 to 13.3 items per patient per annum. This has significant resource implications and consequences for avoidable patient harms. Consequently, we aimed to test a risk management model to identify, measure, and reduce repeat prescribing system risks in primary care.
  
  
  METHODS
  All 48 general medical practices in National Health Service (NHS) Lambeth Clinical Commissioning Group (an inner city area of south London in England) were recruited. Multiple interventions were implemented, including educational workshops, a web-based risk monitoring system, and external reviews of repeat prescribing system risks by clinicians. Data were collected via documentation reviews and interviews and subject to basic thematic and descriptive statistical analyses.
  
  
  RESULTS
  Across the 48 participating general practices, 62 unique repeat prescribing risks were identified on 505 occasions (eg, practices frequently experiencing difficulty interpreting medication changes on hospital discharge summaries), equating to a mean of 8.1 risks per practice (range: 1-33; SD = 7.13). Seven hundred sixty-seven system improvement actions were recommended across 96 categories (eg, alerting hospitals to illegible writing and delays with discharge summaries) with a mean of 15.6 actions per practice (range: 0-34; SD = 8.0).
  
  
  CONCLUSIONS
  The risk management model tested uncovered important safety concerns and facilitated the development and communication of related improvement recommendations. System-wide information on hazardous repeat prescribing and how this could be mitigated is very limited. The approach reported may have potential to close this gap and improve the reliability of general practice systems and patient safety, which should be of high interest to primary care organisations internationally.
authors.affiliation: Medical Protection Society, Leeds, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Price
authors.affiliation: NHS Lambeth Clinical Commissioning Group, London, UK.
authors.forename: Shu Ling
authors.initials: SL
authors.lastname: Man
authors.affiliation: Invigilatis, London, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bartlett
authors.affiliation: Medical Protection Society, Leeds, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Taylor
authors.affiliation: Medical Protection Society, Leeds, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Dinwoodie
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, UK.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0001-6027-2559
authors.initials: P
authors.lastname: Bowie
mesh_terms: D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D004502:Education, Medical, Continuing / Q000458:organization & administration; D058006:General Practice / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D061214:Patient Safety / Q000592:standards / Q000706:statistics & numerical data*; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration; D018570:Risk Assessment; D012308:Risk Management; D013222:State Medicine / Q000592:standards / Q000706:statistics & numerical data; D006113:United Kingdom
keywords: information technology; medication safety; patient safety; primary care; risk management