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Two major national studies, conducted by staff in the Unit and colleagues from a number of other institutions, provide the most comprehensive estimate to date of the prevalence of prescribing errors in general practice in England. These studies identified a number of strategies for reducing these prescribing errors that have been endorsed by the General Medical Council (GMC). Other impacts from these studies include increased public understanding and debate through media coverage, changes to GP education to be implemented by the Royal College of General Practitioners (RCGP), improvements to computerised prescribing decision support for general practitioners and increased awareness of the medication safety role of primary care pharmacists.
Patient safety research from Manchester Pharmacy School at the University of Manchester (UoM) has reduced prescription errors in primary and secondary care. Pharmacists using our indicators with patients' electronic health records (aimed at preventing drug-related morbidity in general practices) reduced the odds of prescribing and monitoring problems by at least 22%. These indicators are now incorporated into `medicines optimisation' software for general practice computer systems. The EQUIP study led changes in the recommended design of hospital prescription charts, an annual national assessment of prescribing competence of medical students and the employment of extra hospital pharmacists to prevent the 9% of prescriptions with errors from harming patients.
Research undertaken on prescribing strategy by the Centre for Medicines Optimisation (School of Pharmacy) is embedded in NHS policy for medicines management. Keele's bespoke reports for the West Midlands Region provided the template for national performance management of primary care prescribing. Linked educational outreach studies established the use of community pharmacists as change agents. Both of these approaches are referenced in separate National Audit Office reports. In addition, Keele piloted risk sharing between pharmaceutical companies and the NHS, now adapted in DH Joint Working Guidelines and NICE policy. Their work on effective shared care is referenced in the 2013 GMC guidance on good practice in prescribing. These principles have been adapted for their WHO government level reports.
Our ground-breaking research has driven major changes in non-medical prescribing (NMP) legislation. As a result of our research, over 19,000 nurses and 2,000 pharmacists now independently prescribe medicines directly to patients across the most comprehensive range of medicines in the world. This amounts to four million prescriptions per year in England. NMP has improved the quality and efficiency of health care: patients can now access prescribed medicines faster and NMP has reduced the number of professionals required. Study results have also contributed significantly to a recent extension of independent prescribing powers to physiotherapists and podiatrists. Our research is widely cited in international NMP policy development, and our survey methods and evaluation measures are used to assess NMP quality and safety internationally.
Leeds researchers first proposed and tested the concept of a pharmacist-led clinical medication review and showed its effectiveness in care homes. This led to a collaborative study on medicines' safety in care homes which showed seven out of ten residents, on any one day, had at least one medication error. As a direct result, there was a ministerial-led summit, and the Department of Health (DH) issued a `Health Alert' requiring NHS trusts to take immediate action, citing the study findings. This was followed by several national initiatives to take forward the recommendations of the study, including a DH commissioned initiative involving Royal Colleges, the National Care Forum, the Health Foundation and Age UK. Prototype tools developed on the basis of our research and with Leeds input were reported in 2012 and are now being evaluated for national roll out.
Research by the University of Southampton has contributed significantly to reducing the global threat of antibiotic resistance. A series of both conventional placebo-controlled and novel open design trials has influenced a number of important national clinical guidelines for Respiratory Tract Infections (RTIs) and the implementation of novel prescribing strategies that discourage unnecessary antibiotic prescription. As a direct result of the research, delayed prescribing for all acute respiratory infections is a tool in the everyday practice of the UK's GPs. Southampton's work in this field has informed international guidelines currently in place in the United States, Israel and the European Union.
This work has formed the basis for a new pharmacy service that has now been commissioned for nursing homes in N. Ireland. It has been recognised that prescribing of medications for older people in nursing homes has been inappropriate, with overuse of medicines that are not clinically indicated. In collaboration with colleagues in the USA, the development and implementation of the Fleetwood Model, a pharmacy intervention service, has led to a reduction in the inappropriate prescribing of psychoactive medications (anti-psychotics, hypnotics and anxiolytics) which can cause sedation and other side-effects, and was shown to be cost-effective.
Research conducted at the University of Aberdeen into the treatment of depressive disorder in primary care has directly led to the revision of health care policy by the Scottish Government Health Department. The work initiated debate over the validity of tools for the assessment of depression, contributing to revision of the Quality and Outcomes Framework (QOF), a system for the performance management and payment of GPs in the NHS in the UK. The findings are now being discussed in commentaries on the development of forthcoming disease classification systems for depression in the US (Diagnostic and Statistical Manual DSM-revision V) and Europe (International Classification of Disease — ICD revision 11).
Therefore the claimed impact is on: health and welfare; changes to public policy and on impact on practitioners and services.
Work led by Professor Nick Barber at the UCL School of Pharmacy showed that a majority of patients have problems soon after starting a new medicine for a chronic condition, and this led to the development of a post-consultation intervention by pharmacists that was shown to be more effective and cheaper than normal care. This entered Department of Health policy for pharmacy in 2008 and Barber helped design the New Medicines Service that was launched in October 2011. This service is offered by community pharmacists in England and by the end of May 2013 over a million patients had received the service. The intervention increases patient adherence to medication, thus improving quality of care, and reducing cost to the NHS from wastage. It also improves patient safety through better identification and resolution of adverse effects.
University of Bradford research into medication error management has directly impacted upon policy and practice, informing changes to mitigate potential harm across the 49 children's hospice services in the UK. Implementation of a research-informed medicines management toolkit co-produced by the Bradford team and Children's Hospices UK (now Together for Short Lives) resulted in hospices identifying key vulnerabilities and using guidance from the toolkit to make significant service improvements. This impact of this research has resulted in changes in both practice and behaviour by strengthening systems for error reporting including the analysis of contributory factors — staff are now identifying more errors and near misses, consequently leading to a reduced risk to the children.