Prevalence of high risk medicines use reports (Wales)

Indicator Name

Description of conditions

EHCP Recommendations

1. Warfarin and INR monitoring

1. Number of patients dispensed a prescription for warfarin

AND

2. Whose latest INR result is not recorded in the pharmacy’s Patient Medication Record (PMR) system

1. First, access the Prescriptions Report and set the date filter for the month data is collected. Under the “Prescribed Item” filter, enter the term “Warfarin” to display all instances when any Warfarin preparation was prescribed. Note: you may need to run an additional, separate report if the item was prescribed by its brand name.

2. Export this list to Excel.

3. Next, you will need to find all patients whose INR reading was recorded in the application. Access the Patient Clinical Monitoring Manager select the Report button. Select: “Detailed Report”; set the date filter for the appropriate month; set the “Measurement Type” to International Normalised Ratio; and finally output the results to Excel.

4. Compare the two reports generated. Here you will need to do some manual manipulation to exclude patients whose latest INR has been recorded.

Note: If you record the INR results using an alternative method (i.e. Counselling Notes, Interventions, etc.), you may need to create separate reports to compare against the list generated by the first list.

2. Dosing instructions for methotrexate

1. Number of patients dispensed a prescription for methotrexate

AND

2. The prescription contains no or non-specific directions for use (e.g. “to be taken as directed”)

1. First, access the Prescriptions Report and set the date filter for the month data is collected. Under the “Prescribed Item” filter, enter the term “Methotrexate” to display all instances when any Methotrexate preparation was prescribed. Note: you may need to run an additional, separate report if the item was prescribed by its brand name.

2. Export this list to Excel.

3. In Excel, you can use the features to filter for only the dosage instructions required.

3. Verapamil in combination with beta-blockers

1. Number of patients dispensed a prescription for verapamil

AND

2. Who are also dispensed a prescription for a beta-blocker

1. First, access the Prescriptions Report and set the date filter for the month data is collected. Under the “Prescribed Item” filter, enter the term “Verapamil” to display all instances when any Verapamil preparation was prescribed. Note: you may need to run an additional, separate report if the item was prescribed by its brand name.

2. Export this list to Excel.

3. Next, access the PDUR.

4. Use the patients that appeared in the Prescriptions Report:

a. Select the Patient Demographics checkbox, then select the Humans checkbox.

b. Add each patient that appeared in the Prescriptions Report

5. Then select the following Printing Details:

a. Prescribed Drug

b. Dispensed Drug

c. Patient Name

d. Address / Nursing Home

e. Date of Birth

6. Export the report to Excel. In Excel, you can use the features to filter out the items that are not beta-blockers.

4. Use of valproate in girls and women of childbearing potential (1)

1. Number of patients dispensed a prescription for sodium valproate or valproic acid

AND

2. Who are female

AND

3. Who are aged between 13 and 45

1. First, access the Prescriptions Report and set the date filter for the month data is collected. Under the “Prescribed Item” filter, enter the term “Sodium valproate” to display all instances when any Sodium valproate preparation was prescribed. Note: you may need to run an additional, separate report if the item was prescribed by its brand name.

2. Export this list to Excel. Note: if you do not have many records, you can use the Excel features to filter for the female patients that fall within this age range.

3. Next, change the “Prescribed Item” filter to contain “Valproic acid” to display all instances when any Valproic acid preparation was prescribed. Note: you may need to run an additional, separate report if the item was prescribed by its brand name.

4. Export this list to Excel. Note: if you do not have many records, you can use the Excel features to filter for the female patients that fall within this age range.

5. If you have a larger number of patients, access the PDUR.

6. Use the patients that appeared in the Prescriptions Report:

a. Select the Patient Demographics checkbox, then select the Humans checkbox.

b. Add each patient that appeared in the Prescriptions Report

c. Select the Age Between checkbox and enter “From 13 To 45” years.

7. Then select the following Printing Details:

a. Prescribed Drug

b. Dispensed Drug

c. Patient Name

d. Address / Nursing Home

e. Date of Birth

f. Sex

8. Export the report to Excel. Export the report to Excel and filter out the male patients.

5. Use of valproate in girls and women of childbearing potential (2)

Of the patients identified in number 4, the number who have been provided the patient information booklet

No report exists within the application to identify this. Please refer to your own SOPs.

Indicator Name

Description of conditions

EHCP Recommendations

6. Over 65s prescribed an antipsychotic medicine

1. Numbers of patients dispensed prescriptions for antipsychotic medicine

AND

2. where the patient is aged 65 or over

1.  First, access the Patient/Drug Use Report (PDUR).

a. Set the date filter for the month data is collected.

b. Next select the Patient Demographics checkbox and set the Age Between filter from 65 to 120 years.

2.  Then select the following Printing Details:

 a. Prescribed Drug

 b. Dispensed Drug

 c. Patient Name

 d. Address / Nursing Home

 e. Date of Birth

3.  Export the report to Excel

4. In Excel, you can use the features to   filter out the items that are antipsychotics.

7. Warfarin and oral NSAIDs

1. Number of patients dispensed a prescription for warfarin

AND

2. Who are also dispensed a prescription for an oral Non -Steroidal Anti – Inflammatory Drug (NSAID)

1.  First, access the Prescriptions Report and set the date filter for the month data is collected. Under the “Prescribed Item” filter, enter the term “Warfarin” to display all instances when any Warfarin preparation was prescribed.

2.  Export this list to Excel.

3.  Next, access the PDUR.

4.  Use the patients that appeared in the Prescriptions Report:

a. Select the Patient Demographics checkbox, then select the Humans checkbox.

b. Add each patient that appeared in the Prescriptions Report

5.  Then select the following Printing Details:

a. Prescribed Drug

b. Dispensed Drug

c. Patient Name

d. Address / Nursing Home

e. Date of Birth

6.  Export the report to Excel. In Excel, you can use the features to filter out the items that are NSAIDs.

8. NSAIDs in combination with Aspirin or Clopidogrel without gastroprotection

1. Number of patients dispensed a prescription for an NSAID

AND

2. Who are also dispensed a prescription for Aspirin or Clopidogrel

AND

3. Who are not dispensed a prescription for suitable gastroprotection (PPI or H2 antagonist) AND

4. are aged 65 or over

1.  First, access the Prescriptions Report and set the date filter for the month data is collected.

2. Under the “Prescribed Item” filter, enter the term “Clopidogrel” to display all instances when any Clopidogrel preparation was prescribed.

3.  Export this list to Excel.

4.  Next, access the PDUR.

5.  Use the patients that appeared in the Prescriptions Report:

a. Select the Patient Demographics checkbox, then select the Humans checkbox.

b. Add each patient that appeared in the Prescriptions Report

c. Select Age Between checkbox, then set age range from 65 to 120 years.

5.  Then select the following Printing Details:

a. Prescribed Drug

b. Dispensed Drug

c. Patient Name

d. Address / Nursing Home

e. Date of Birth

6.  Export the report to Excel.

7.  In Excel, you can use the features to filter out the items that are NSAIDs and then review each patient individually (via their PMR) to assess whether they are also prescribed a PPI or H2 antagonist for gastroprotection.

8. Repeat from step 1 for Aspirin.

9. Excessive use of short acting bronchodilators in asthma

1. Number of patients who have been dispensed prescriptions or received emergency supplies (combined total) of more than 6 inhaled short acting beta agonists in the previous 6 months

AND

2. Who have not been prescribed an inhaled corticosteroid in the previous 6 months

1. First, access the Report Builder.

2. Select QPS: Asthma Referral Report and run selected report. Please note the date will automatically be set for 6 months period.

3. Export the report to Excel to display all patients who meet the set criteria.