Intended for healthcare professionals


Safety, trust, and money are uncomfortable bedfellows

BMJ 2015; 351 doi: (Published 03 November 2015) Cite this as: BMJ 2015;351:h5750
  1. Stephen Chapman, professor of prescribing and head of medicines optimisation1,
  2. Therese Curtis, real patient volunteer2
  1. 1Centre for Medicines Optimisation, School of Pharmacy, Keele University, Staffordshire ST5 5BG, UK
  2. 2Newcastle under Lyme, Staffordshire, UK
  1. Correspondence to: S Chapman s.r.chapman{at}

Addressing safety should not need financial incentives

Safer prescribing has been an objective for physicians since Hippocrates. Yet medicines, although yielding massive net benefit at the population level, continue to cause harm to a considerable proportion of individual patients. Around 5% of hospital admissions could be associated with inappropriate prescribing.1 2

So what reduces errors? The PINCER trial3 compared simple feedback on prescribing errors with a pharmacist led intervention involving feedback, educational outreach, and dedicated support to GP practices. After six months’ follow-up, patients in the pharmacist led group were significantly less likely to have triggered indicators of unsafe prescribing such as receiving a β blocker if they had asthma or an ACE inhibitor or loop diuretic without appropriate monitoring. In a linked paper, Stocks and colleagues (doi:10.1136/bmj.h5501)4 took this one step further and extrapolated the indicators developed from the PRACTICE study5 to a representative sample of over 500 general practices using the Clinical Practice Research Database.

Within the composite indicators are some uncomfortable figures—in some practices, nearly 20% of patients taking aspirin or clopidogrel …

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