NSAID clinical audit

NSAID clinical audit

If you haven’t yet completed a clinical audit, a ready-made audit is available on PharmOutcomes for all pharmacy contractors (or local NHS England teams) to use.

Community Pharmacy NSAID Audit on Gastrointestinal Safety

This audit was developed by the NHS East & South East England Specialist Pharmacy Services (now known as the NHS Specialist Pharmacy Services (SPS)) medicines use and safety team.

The audit has been added to PharmOutcomes so completion of the audit paperwork is easy. If you need to refer a patient back to their GP, PharmOutcomes will create a referral letter for you to use. Adding your data to PharmOutcomes will also help the profession amass further evidence of the impact of community pharmacy interventions on patient safety.

Background to the audit

Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) including cyclo-oxygenase-2 (COX2) selective inhibitors are a frequent cause of hospital admissions which are potentially preventable. The adverse effects include gastrointestinal bleeds, pro-thrombotic events (e.g. heart attack, stroke) and reduced renal blood flow leading to acute kidney injury.

This audit looks only at gastrointestinal safety. NICE guidance requires all patients prescribed NSAIDs for osteoarthritis or rheumatoid arthritis (no age limit) or for low back pain (if aged over 45) to be co-prescribed gastro-protection (e.g. a proton pump inhibitor). Any patient prescribed prolonged treatment with an NSAID is classed as ‘high risk’ for gastrointestinal bleeding. The risk is particularly high for elderly patients.

How do I undertake the audit?

1) The full audit details can be downloaded from the SPS website.

To collect a useful sample for this audit it is suggested that data is collected over approximately 2 weeks or until you have seen at least 10 patients.

2) You can record the details of each patient that presents a prescription for an NSAID or COX2 inhibitor straight onto PharmOutcomes, in order to save time and effort. Alternatively you can use the audit data collection sheet and then enter the data on PharmOutcomes at a later time.

NSAID audit data collection sheet

When you log into PharmOutcomes select Services; you should see NSAID Safety Audit under the National Audits heading.

If you have mislaid your PharmOutcomes login details, visit the Help page.

3) If you need to refer a patient to their GP, once you have entered the data into PharmOutcomes, it will allow you to print a referral letter.

4) Once you have completed the data collection, and have entered it into PharmOutcomes you will be able to create a report that includes the results of your audit. You can access this special report from within any recorded provision for the audit, in the left hand bar with a link “Audit Report (Word/OpenOffice)” that will download a file that opens in Microsoft Word or OpenOffice. The report provides space for you to enter your reflections on the results and any follow up actions you may decide to take. PharmOutcomes will also benchmark your pharmacy’s data against the data entered by other pharmacies across the country.


Audit sample – All patients who present prescriptions for any oral NSAID or COX2 inhibitor.

Audit standards

Standard 1 Gastro-protection – All patients, regularly prescribed an oral NSAID or COX2 inhibitor for more than 2 months are co-prescribed gastro-protection.

Audit standard = 90% (Not 100% as some patients may be unable or unwilling to take gastro-protection)

Standard 2 Verbal advice – All patients presenting prescriptions for an oral NSAID or COX2 inhibitor, whether regular medication or not, are offered verbal advice about their medicines.

Audit standard = 100%


Results

In 2014,  the audit was used by 1,278 community pharmacies who between them audited 16,366 patients prescribed NSAIDs, looking to see whether they had also been prescribed gastro-protection in line with NICE standards.

In an analysis of the audit results the SPS found that:

  • 6,475 (40%) of patients prescribed NSAIDs had not been co-prescribed gastro-protection;
  • 1,669 (10%) were aged over 65, meaning they were at particular risk of gastro-intestinal damage, and had not been prescribed gastro-protection; and
  • 2,838 (27.5%) of patients had used NSAIDs regularly for more than two months and had no gastro-intestinal protection.

This means 27.5% of prescriptions for NSAIDs may not be meeting clinical guidelines which state that patients regularly prescribed an oral NSAID or COX2 inhibitor on a long-term basis should be co-prescribed gastro-protection; putting some patients at risk of complications.

Pharmacies offered 65% of the patients they audited advice on their medicines and 2,138 patients not prescribed gastro-protection were referred to their GPs.

The audit was the first of its kind to be carried out on a national scale and is still available for pharmacies to use via PharmOutcomes.

Further information

National data from PharmOutcomes – Community pharmacy Non-Steroidal Anti-Inflammatory Drug safety audit 2014

CPPE Workshop: Working together for patient safety: a full day GP and pharmacist learning event (NSAID focus)



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