Development of prescribing-safety indicators for GPs using the RAND Appropriateness Method

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. AIM: To identify a set of potential prescribing-safety indicators for the purposes of revalidation of individual GPs in the UK. DESIGN AND SETTING: The RAND Appropriateness Method was used to identify, develop, and obtain agreement on the indicators in UK general practice. METHOD: 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. CONCLUSION: 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