National audit data reiterates community pharmacy’s role in medicines optimisation

National audit data reiterates community pharmacy’s role in medicines optimisation

Community pharmacy teams taking part in an acute kidney injury (AKI) audit have interacted with nearly 15,000 patients to deliver hydration messages for those with antibiotics prescribed for urinary tract infections or those seeking advice on urinary symptoms.

The AKI audit is available on the PharmOutcomes electronic recording system and was developed by the NHS Specialist Pharmacy Service (SPS), with input from PSNC, the Centre for Pharmacy Postgraduate Education (CPPE), NHS England, PharmOutcomes and the NHS ‘Think Kidneys’ programme.

Over a nine-month period (1st November 2015 to 31st July 2016) 962 pharmacy teams recorded audit data electronically via the PharmOutcomes system for 14,908 patients. Coverage across England was good, with at least 75 pharmacies reporting from each NHS region, and representation from 176 of the 211 (83%) Clinical Commissioning Group areas.

AKI Audit Q&A

Q. What is the AKI audit?
The AKI audit is a readymade audit available on PharmOutcomes for all contractors (or local NHS England teams) to use. It can be used as pharmacies’ annual clinical audit and was designed to be as straightforward as possible to help busy pharmacies.

Q. How much time will the audit take?
To collect a useful sample for this audit it is suggested that data is collected over approximately two weeks or until you have seen at least 15 patients.

Q. How can pharmacy teams use the audit?
The details of each patient who fall into the audit sample can be recorded straight onto PharmOutcomes. Alternatively, the AKI audit data collection form can be used and then the data could be entered on PharmOutcomes at a later time. If you need to refer a patient back to their GP, PharmOutcomes will create a referral.

Q. Where do I go for more information?
More information about the audit can be found on the AKI audit page. Alternatively, when you log into PharmOutcomes select Services; and you should see Prevention of Acute Kidney Injury audit under the National Audits heading.

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

  • 13,980 (94%) patients received hydration advice from pharmacy teams. Advice provision was slightly higher for patients requesting over-the-counter advice (97%) than for patients with a prescription (93%);
  • most patients (91%) had prescriptions for antibiotics, with trimethoprim being most commonly prescribed (59%) and then nitrofurantoin (39%), despite national guidance suggesting nitrofurantoin should be first-line. In addition, the duration of treatment was often not aligned with national guidance; and
  • one third of the sample were taking other medicines which have the potential to impair renal function, with over 10% taking two or more. For patients aged 65 or over, more than half were on these medicines.

The analysis shows that community pharmacists are well placed to target advice to patient groups at increased risk of AKI and that pharmacy teams can play a significant part in the provision of hydration advice to key patient groups, such as those with urinary symptoms. However, additional strategies are needed to support some particularly vulnerable groups such as older housebound patients and those in residential care.

Further information

SPS – AKI audit results

SPS – AKI audit details

SPS – AKI data collection form

CPPE – Leaning campaign: acute kidney injury

Find out more about the annual clinical audit requirement on the PSNC Clinical Audit page.

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