Quality Payments – NSAID audit
Quality Payments – NSAID audit
Community pharmacy contractors passing the gateway criteria will receive a Quality Payment if they meet one or more of the quality criteria. One of the quality criteria is:
‘On the day of the review the pharmacy must have completed the audit of non-steroidal anti-inflammatory drugs and gastro-protection available under the following link – https://www.sps.nhs.uk/articles/nsaid-safety-audit-2018-19/, for patients 65 or over, notified the patient’s GP where professional concerns were identified, share their anonymised data with NHS England and incorporated the learning of the audit into future practice.’
Click on a heading below for more information.
NHS England guidance
NHS England has published guidance for the February 2019 review point of the Quality Payments Scheme. The new guidance should be read in conjunction with NHS England’s previously published gateway criteria and quality criteria guidance:
- NHS England – Pharmacy Quality Payments Gateway Criteria Guidance (published 23rd December 2016); and
- NHS England – Pharmacy Quality Payments Quality Criteria Guidance (published 27th February 2017).
These documents are available on the NHS England website.
Quality criterion points and value
The value of this quality criterion is as follows:
|Total points for the February 2019 review point||20|
|Value of total points||£640-1280*|
*The funding will be divided between qualifying pharmacies based on the number of points they have achieved. Each point will have a minimum value worth £32 and a maximum of £64.
Aim/rationale of this quality criterion
The aim of this quality criterion is to reduce preventable patient harm from adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) including cyclooxygenase-2 (COX2) inhibitors.
Adverse effects of NSAIDs including COX2 selective inhibitors are a frequent cause of hospital admissions which are potentially preventable. The adverse effects include gastro-intestinal (GI) bleeds, pro-thrombotic events (e.g. heart attack, stroke) and reduced renal blood flow leading to acute kidney injury. This audit looks only at GI safety.
All older patients (aged 65 and over) are at increased risk of NSAID induced GI adverse effects. Additional risk factors include prolonged treatment and concomitant use of other medicines which increase the likelihood of GI events. GI adverse events have also been reported where patients have self-medicated with a second NSAID in addition to the prescribed agent or have not taken a gastro-protective medicine despite this being co-prescribed.
How to achieve this quality criterion (includes audit paperwork)
The aims of the audit
- To identify older patients (65 years or over) at increased risk of a GI toxicity from oral NSAIDs
- To refer older patients with no prescribed gastro-protection to prescribers for review
- To support patient understanding and decision making about their NSAID/COX2 medicines
When should the audit be completed?
Data must be collected for two weeks with a minimum sample size of ten patients. In cases where there is difficulty in obtaining the minimum sample size, the audit should be extended to four weeks after which contractors will be able to submit the data with the number of patients they have if less than ten.
Please note, the deadline to submit audit data is 15th February 2019, so contractors are advised not to start this audit in February, if there is a likelihood that they will be unable to find the minimum required sample size and they need to extend the data collection period to four weeks.
The audit paperwork
You can download a copy of the audit guidance document from the Specialist Pharmacy Service (SPS) website.
How to complete the audit
Data must be collected for two weeks with a minimum of ten patients participating in the audit. All patients aged 65 years or over who present a prescription for any oral NSAID or cyclo-oxygenase-2 (COX2) selective inhibitor (this does not include patients prescribed aspirin) should be included in the audit. In cases where there is difficulty in finding 10 patients to participate, the audit should be extended to four weeks after which contractors can submit the data with the number of patients they have if less than ten.
Contractors can choose to enter the data directly onto a web-based platform or use the paper form (a standalone form is available above) to collect the data and then transfer the data onto a web-based platform to submit their results to NHS BSA. Two web-based systems are available for the audit; PharmOutcomes* or the NHS BSA Snap Survey.
Having reviewed both systems, PharmOutcomes has the following advantages over the NHS BSA Snap Survey:
- PharmOutcomes can send an automatic referral letter to a patient’s GP practice (if the NHS BSA Snap Survey is used, contractors will need to manually send this referral letter (a template letter is available at psnc.org.uk/qpaudit);
- A permanent patient record will be stored on PharmOutcomes; and
- Contractors will not be required to submit their data once they have entered all their audit data onto PharmOutcomes, the system will automatically do this for contractors (if using the NHS BSA Snap Survey, contractors will need to remember to press the ‘Submit’ button once they have completed all their data entry for this to be submitted to NHS BSA. Failure to submit the data will mean the contractor does not meet the NSAID quality criterion).
If contractors decide to use PharmOutcomes, the following additional patient information will need to be collected (which is not required on the SPS audit data collection form): patient name, whether the patient has an accessible information need, date of birth, address and postcode. Therefore, contractors are advised to either enter the data directly onto PharmOutcomes or use the PharmOutcomes data collection form rather than the SPS audit data collection form to collect the data.
Both of the web-based systems will calculate a contractor’s results. If PharmOutcomes is used, contractors will be able to access the results in the ‘Reports’ section and can print this off as evidence of meeting the NSAID quality criterion. If the NHS BSA Snap Survey is used and the contractor enters an email address when submitting their results, the contractor will be emailed the results of their audit; this email should be retained as evidence of having met the NSAID quality criterion.
*The NSAID audit on PharmOutcomes is freely available to all contractors; PSNC has agreed to use their licence to provide access.
Please note: Where a contractor is unable to complete the NSAID audit due to the fact that they have not identified any eligible patients during the audit period the contractor should send an email to the NHS BSA Provider Assurance Team at: firstname.lastname@example.org with the following details:
The subject should state “QPS NSAID AUDIT Nil return for [F code]”
The main body of the email should contain:
- Pharmacy F code
- Pharmacy name
- Pharmacy address
- Start date of the audit
- End date of the audit
- The following text should be included in the body of the email:
“I declare that this pharmacy has undertaken the audit of non-steroidal anti-inflammatory drugs and gastro-protection for patients aged 65 or over during the period stated above but no suitable patients have been identified. I am therefore unable to complete the on-line audit tool.
I acknowledge that NHS BSA may carry out checks on behalf of NHS England to determine if any patients over 65 have received dispensed NSAID items from the pharmacy during the period advised”
- Name of person making declaration and their role in the pharmacy
Accessing the NSAID audit on PharmOutcomes
Once a contractor has logged into PharmOutcomes, the NSAID audit can be accessed by clicking on the ‘Services’ tab on the PharmOutcomes homepage; you should see ‘NSAID GI Safety Audit 2018/19’ under the ‘National Audits’ heading.
Once all the audit data has been logged on PharmOutcomes, the system will calculate the results of the audit. Contractors will be able to access the results in the ‘Reports’ section; this can be printed out and retained as evidence of meeting the NSAID quality criterion.
PharmOutcomes log in details
If a contractor has not used PharmOutcomes before, log in details can be obtained by sending a message to the PharmOutcomes helpdesk. Contractors will need to provide details of the pharmacy, contact information and an email address to issue the login details to.
If a contractor has mislaid their PharmOutcomes login details, visit the Help page.
Actions to be taken following the submission of your data
Once you have submitted your data, consider possible areas to be addressed in your pharmacy practice, such as:
- Is there a problem ensuring NSAID safety because patients are not 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.
The declaration process
Contractors will be required to declare through the NHS BSA online declaration page (the portal will go live on Monday 4th February 2019 at 9am and will be available until Friday 1st March 2019 at 11.59pm) that they have completed the audit and submitted this to the NHS BSA.
FAQs on the Quality Payments Scheme can be found on the Quality Payments – FAQs page.