NSAID audit


NOTE: The claims deadline for February 2019’s Quality Payments was Friday 1st March 2019. We will update these pages as soon as we know whether there will be a Quality Payments scheme in 2019/20. In the meantime, these pages are here for archive purposes.

Download this page as a PDF.

NSAID audit

Points available: 20 points (£640-£1,280) available.

Requirements:

You must have:

  • Completed the NSAID audit for patients aged 65+
  • Notified the patient’s GP if you identified any professional concerns
  • Shared their anonymised data with NHS England
  • Incorporated learning from the audit into pharmacy practice

About the audit:

Non-steroidal anti-inflammatory drugs (NSAIDs) can cause avoidable harms such as gastrointestinal bleeding, stroke and heart attack. This risk increases as people age, which is why NICE recommends that people aged 65+ who are taking NSAIDs for osteoarthritis or rheumatoid arthritis should also be prescribed a proton pump inhibitor (PPI) for gastro-protection. However, PPIs also have some risks and NICE guidance CG 184 explains the current recommendations.

Read the guidance on the Specialist Pharmacy Service website. The PDF at the bottom of that page includes full details of the inclusion criteria, the list of relevant NSAIDs and COX2 medications, and associated guidance.

Audit inclusion criteria

All patients aged 65+ who present a prescription for any oral NSAID (except aspirin) or COX2 inhibitor. [There is a full list in the audit guidance mentioned above.]

Audit standards

  • 1A: All patients aged 65+ prescribed an oral NSAID or COX2 inhibitor are co-prescribed gastroprotection.
  • 1B: All patients aged 65+ prescribed an oral NSAID or COX2 inhibitor but not co-prescribed gastroprotection are referred to the prescriber for review unless such a referral has been made in the previous 6 months.
  • 2: Verbal advice/ conversation is offered to all audit patients to support understanding/decision making about their NSAID/COX2 medicine.

The audit standard is 100% for all three measures but SPS says it recognises that, in practice, this may not be achievable e.g. due to patient choice.

When to do the audit

Don’t put it off. We would strongly advise starting the audit no later than 7th January. That’s because you must have completed and submitted your audit by 15th February – and the audit could take up to four weeks, depending on patient numbers.

  • The audit should last two weeks, with a minimum of 10 patients.
  • If you don’t identify 10 patients in the first two weeks, you should continue for up to four weeks.
  • ·After four weeks, you can submit your results even if you had fewer than 10 patients.

Templates for data collection & referrals

Submitting your audit results:

Enter your data into the online form for submission. There are two ways of doing this:

  • PharmOutcomes – this has some advantages over Snap Survey but requires you to enter some additional patient information
  • NHS BSA Snap Survey

PharmOutcomes

  • The advantage of using PharmOutcomes is that you can send referral letters direct to patients’ GPs (instead of manually) and information will also be stored in the patients’ records. PharmOutcomes will automatically submit the data for you.
  • All pharmacies can use the NSAID module to submit their results. If you can’t access it, contact PharmOutcomes.
  • Use the PharmOutcomes data collection form, not the SPS one, as you will also need the patient’s name, accessible information needs, date of birth, address and postcode.
  • Log into PharmOutcomes, go to Services, then National Audits, then NSAID GI Safety Audit 2018/19.
  • Enter your audit results.
  • You can download a copy in the Results section of PharmOutcomes and keep this as evidence to claim your Quality Payment.

Snap Survey

  • Send referral letters to GPs, where applicable.
  • Go to the NHS BSA Snap Survey and enter your results. Make sure you include an email address so they can send you confirmation you completed the audit.
  • Click Submit to send your results through.
  • Keep the email from NHS BSA confirming you submitted the audit results as evidence to claim your Quality Payment.

Demonstrating ongoing learning:

To claim the Quality Payment, you also need to demonstrate your learning from the audit. PSNC suggests the following examples:

  • Is there a problem ensuring NSAID safety because patients aren’t present in the pharmacy?
  • Are local prescribers following NICE guidance on gastro-protection?
  • How can these audit checks become ‘normal’ practice?
  • · Any others you think should be addressed.

Full guidance from NHS England

This tip-sheet is just a summary. You must also read the full NHS England guidance to make sure you meet the Quality Payments criteria. There are 3 key documents:

  • Updated guidance for February 2019
  • Gateway Criteria Guidance
  • Quality Criteria Guidance