Implementing prescribing safety indicators in prisons: a mixed methods study.

AIM To examine the prevalence of potentially hazardous prescribing in the prison setting using prescribing safety indicators (PSIs) and explore their implementation and use in practice. METHODS PSIs were identified and reviewed by the project team following a literature review and a nominal group discussion. Pharmacists at two prison sites deployed the PSIs using search protocols within their electronic health record. Prevalence rates and 95% confidence intervals (95%CI) were generated for each indicator. Semi-structured interviews with 20 prison healthcare staff across England and Wales were conducted to explore the feasibility of deploying and using PSIs in prison settings. RESULTS Thirteen PSIs were successfully deployed mostly comprising drug-drug interactions (n=9). Five yielded elevated prevalence rates: use of anticholinergics if aged≥65 (Site B:25.8% (95%CI:10.4-41.2%), lack of antipsychotic monitoring for more than 12 months (Site A:39.1% (95%CI:27.1-52.1%); Site B:28.6% (95%CI:17.9-41.4%)), prolonged use of hypnotics (Site B:46.3% (95%CI:35.6-57.1%)), antiplatelets prescribed with non-steroidal anti-inflammatory drugs (NSAIDs) without gastrointestinal protection (Site A:12.5% (95%CI:0.0-35.4%); Site B:16.7% (95%CI:0.4-64.1%)), and selective serotonin/norepinephrine reuptake inhibitors prescribed with NSAIDs/anti-platelets without gastrointestinal protection (Site A:39.6% (95%CI:31.2-48.4%); Site B:33.3% (95%CI:20.8-47.9%)). Prison healthcare staff supported the use of PSIs and identified key considerations to guide its successful implementation, including staff engagement and PSI 'champions'. To respond to PSI searches, stakeholders suggested contextualised patient support through intra-professional collaboration. CONCLUSION We successfully implemented a suite of PSIs into two prisons, identifying those with higher prevalence values as intervention targets. When appropriately resourced and integrated into staff workflow, PSI searches may support prescribing safety in prisons.