Shared learning database

NHS Wakefield District
Published date:
February 2011

ScriptSwitch® is a prescribing software support tool that is installed in all GP practices in Wakefield District. ScriptSwitch® enables a 'pop up' message to appear at the point of prescribing, which can be utilised to communicate cost effectiveness, formulary choices and regional/local guidelines. ScriptSwitch® is therefore an appropriate and effective medium to highlight NICE guidance to prescribers, especially in relation to the prescribing of medicines.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The main aim was to provide key NICE guidance relating to prescribing in a prompt and efficient manner to prescribers in the Wakefield District utilising the ScriptSwitch® software as the information vehicle. ScriptSwitch® messages are seen by the majority of prescribers on a regular basis and therefore the perfect tool to communicate information on demand. Providing information via ScriptSwitch® would promote consistency and quality of prescribing, as well as highlighting cost effectiveness and reducing risks. The ScriptSwitch® information message can be as concise or informative as required and can contain hyperlinks, for example, to the NICE clinical guideline associated with the medication that has just been prescribed. This provides prescribers with the opportunity to review the guidelines in more detail instantaneously. 1) To increase awareness of new or updated NICE guidelines to prescribers in the Wakefield District. 2) To provide the prescribers with instant hyperlinks to the appropriate NICE guideline at the point of prescribing. 3) To identify how ScriptSwitch® software could be utilised to its maximum potential, without being too invasive. 4) To ensure that the ScriptSwitch® Information messages are useful and appropriate through gaining feedback from prescribers. 5) To utilise the ScriptSwitch® Analytics Reporting tool to identify the actions taken by prescribers in response to the NICE information message seen at the point of prescribing a particular medicine. 6) To ensure that information messages based on NICE guidance are kept up to date and relevant to prescribers. 7) To make sure that messages are kept concise but informative.

Reasons for implementing your project

Historically, it has been imperative role of the Medicines Management Team to ensure that steps have been taken to communicate key messages to prescribers about NICE guidance relating to the prescribing of medicines in Primary Care. A variety of methods have been utilised to ensure that relevant NICE guidance is communicated to prescribers in an effective and practical manner, such as producing prescribing bulletins, presenting updates to or new NICE guidelines at prescribing seminars and via practice meetings, but this has been highly dependent on the Medicines Management Team producing and disseminating the bulletins and delivering workshops that may not reach every prescriber. We required something to substantiate the work that was currently in place. Prescribers regularly fed back that they didn't always see the prescribing bulletins and/or couldn't attend all the prescribing seminars, so we were aware that a new way of communicating key information needed to be identified. ScriptSwitch® was introduced to all GP Practices in Wakefield in January 2010, as a tool to enable to Medicines Management Team to communicate and connect with prescribers at the point of prescribing. One of the main benefits of this kind of prescribing interface is to promote cost effectiveness, although as we soon became more aware of its capabilities, we recognised that it would be key in communicating 'information only' messages to prescribers where most appropriate and useful. The addition of NICE guidance relating to medicines prescribed in Primary Care to the recommendation profile was done gradually and updates made as and when required.

How did you implement the project

NICE guidance information has been gradually added on to the ScriptSwitch recommendation profile through prioritisation and demand. As and when new guidance is received or update made to previous guidance, this is summarised and added onto the profile if, we feel that it is useful to provide this information to prescribers. We have to be very vigilant and aware that not all NICE guidance can be added onto the profile as we don't want to disengage prescribers by communicating too much information. There is a fine line between providing too much or too little.

Key findings

Regular feedback is received from general practitioners and non-medical prescribers regularly via meetings and e-mail about the usefulness and content of the information messages. The majority of prescribers have communicated that they find the information highlighting NICE guidance via ScriptSwitch® timely and informative. Some have commented that there is too much information, so this is when we decided to provide web hyperlinks to the NICE guidance. We are able to monitor using the ScriptSwitch® Analytical Reporting Tool, each individual information message seen by prescribers at a particular practice/consortium. This enables us to ascertain if the prescriber(s) went ahead with their original prescribing choice or if they took on board the information message and decided to go back and edit the original item prescribed (to possibly a recommended alternative as recommended by NICE). More in depth analysis is required to show the impact that the messages have in regards to changing the prescribers initial choice of drug. For example; in a specific time period a message was seen by prescribers 22 times about NICE guidance relating to the prescribing of clopidogrel (TA80). 9% of the time, the prescriber went back to edit their original choice assuming this was prompted by the information message. As ScriptSwitch has only been in place for just over a year, there is much in-depth analysis still to be performed to ascertain the full extent of its effectiveness and achievements as some messages have only been on the profile a short while. Additionally, there is still much more NICE information to be added/updated. The communication of NICE guidance is now primarily communicated via ScriptSwitch® and reducing the need to include this information in prescribing bulletins and prescribing seminars.

Key learning points

The use of the ScriptSwitch® software is obviously pivotal to the success of this initiative, as it would be difficult to replicate its efficiency at communicating specific messages at the point of prescribing in person! It is imperative to ensure that messages are fluid, relevant and convey the fundamental points. It is also vital that the profile of messages is maintained by a designated person, as it is essential that NICE guidance is monitored and any updates are reflected immediately. It is also vital to respond to prescriber feedback as they see and respond to the information in the pop up message. Positive engagement and utilisation of ScriptSwitch® between the Medicines Management Team and prescribers is a key component of the success of this initiative.

Contact details

Lyndsey Clayton
Specialist Prescribing Data Analysis Technician
NHS Wakefield District

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Is the example industry-sponsored in any way?