Pharmacy Quality Scheme – Lithium safety audit
Pharmacy Quality Scheme – Lithium safety audit
Community pharmacy contractors passing the gateway criteria will receive a payment for the Pharmacy Quality Scheme if they meet one or more of the quality criteria bundles. The medicines safety audits complementing QOF QI bundle consists of three quality criteria, one of which is that on the day of their declaration (which must be done between 3rd February 2020 and 28th February 2020):
‘the pharmacy must have completed a lithium audit, over three consecutive months, aligned with requirements of the NPSA alert on lithium. A link to the NPSA alert is available in the NHS England & NHS Improvement Pharmacy Quality Scheme 2019/20 guidance under the following link – https://www.england.nhs.uk/primarycare/pharmacy/pharmacy-quality-payments-scheme/pqs/ for all patients prescribed lithium. Further details of the required questions to be asked and the details to be recorded can be found in the NHS England & NHS Improvement Pharmacy Quality Scheme 2019/20 guidance available at https://www.england.nhs.uk/primary-care/ pharmacy/pharmacy-quality-payments-scheme/pqs/.
Before starting the audit, the contractor must check their PMR prior to choosing the consecutive three-month period for the audit to verify whether they have had any ongoing patients to whom they have dispensed lithium in the preceding three months. If the pharmacy has no patients who have had lithium dispensed from the pharmacy in the previous three months, the contractor must complete a safety audit of patients prescribed one of the following medicines instead, in the following order of preference: either methotrexate; amiodarone; or phenobarbital, which are in line with alternatives suggested in the GP QOF QI Prescribing Safety Module (please note that the same process for identifying if the pharmacy has any patients on lithium should be applied for identifying if the pharmacy has any patients on methotrexate, amiodarone or phenobarbital).’
Click on a heading below for more information.
NHS England and NHS Improvement guidance
How to achieve this quality criterion (includes PSNC resources)
Contractors must have started the lithium* audit by 29th November 2019 at the very latest, to be able to meet the requirement to complete the audit over a consecutive three-month period. However, contractors are strongly encouraged to start their lithium* audit well before this date to reduce the risk of missing this deadline and allow themselves more flexibility on the date when they make their PQS declaration. For example, if a contractor does not start their audit until the pharmacy opens on 29th November 2019, they will not complete their audit until 28th February 2020, which means they will also have to also make their PQS declaration on that day (as this is the final day for making a PQS declaration).
*Contractors are only required to complete ONE audit to meet this quality criterion in the following order of preference: lithium; methotrexate; amiodarone; or phenobarbital. See PSNC Briefing 054/19 below which guides contractors through the process of selecting the correct audit to complete to meet the quality criterion.
Briefing 054/19: PQS: Flow chart – How to meet the lithium audit quality criterion
PSNC has published Briefing 054/19: PQS: How to meet the lithium audit quality criterion, which provides contractors with a flow chart on how to meet the quality criterion.
Community Pharmacy Patient Safety Group – Patient safety quality criteria guidance
The Community Pharmacy Patient Safety Group has published guidance on meeting the patient safety quality criteria of the PQS, which includes information on the lithium audit*.
Recording patient data
Contractors can choose to collect the patient data for the audit by using the appropriate NHS England and NHS Improvement (NHSE&I) audit data collection table (available as Annexes 6-9 in the NHSE&I PQS guidance) or on PharmOutcomes.**
NHSE&I audit data collection tables
If contractors would prefer to use one of the NHSE&I data collection tables, PSNC has made these available as standalone documents:
- Lithium – NHSE&I audit data collection table (PDF)
- Methotrexate – NHSE&I audit data collection table (PDF)
- Amiodarone – NHSE&I audit data collection table (PDF)
- Phenobarbital – NHSE&I audit data collection table (PDF)
PSNC has also created template GP referral forms that contractors can choose to use if they need to refer a patient to their GP. A GP referral form has been created for each of the four audits:
- Lithium – GP referral form (Word)
- Lithium – GP referral form (PDF)
- Methotrexate – GP referral form (Word)
- Methotrexate – GP referral form (PDF)
- Amiodarone – GP referral form (Word)
- Amiodarone – GP referral form (PDF)
- Phenobarbital – GP referral form (Word)
- Phenobarbital – GP referral form (PDF)
If contractors decide to use PharmOutcomes, additional patient information will need to be collected (which is not required on the NHSE&I audit data collection tables). Therefore, contractors are advised to either enter the data directly onto PharmOutcomes or use the relevant PharmOutcomes data collection form below for collecting patient information.
- Lithium – PharmOutcomes patient data collection form (PDF)
- Methotrexate – PharmOutcomes patient data collection form (PDF)
- Amiodarone – PharmOutcomes patient data collection form (PDF)
- Phenobarbital – PharmOutcomes patient data collection form (PDF)
**The lithium, methotrexate, amiodarone and phenobarbital audits on PharmOutcomes are freely available to all contractors; PSNC has agreed to use their licence to provide access.
FAQs on the Pharmacy Quality Scheme can be found on the Pharmacy Quality Scheme – FAQs page.