Pharmacist-led information technology intervention (PINCER) is an effective way to reduce errors in prescription and medication monitoring which are responsible for a large proportion of adverse drug events. This is achieved through the monitoring of 13 PINCER indicators.

The purpose of this notebook is to describe practice level changes in adherence to each of the PINCER indicators throughout the COVID-19 pandemic. For each indicator, the number of unique patients experiencing hazardous prescribing described by a given indicator at any point during the study period is provided. The total number of hazardous prescribing events for each indicator is also shown. Practice level monthly rates of hazardous prescribing are calculated, ranked and used to calculate deciles of activity for each indicator, which are represented as decile charts.

The 13 PINCER measures include:

Gastrointestinal (GI) Bleed Indicators
Monitoring Indicators
Other Indicators

Summary¶

	Q1 mean percentage 2020	Q1 mean percentage 2021	Numerator	Denominator	%	Ratio of hazardous prescribing events to unique patients experiencing an event	Number of practices with at least one hazardous prescribing event	% practices with at least one hazardous prescribing event
Indicators associated with gastrointestinal bleeding	-	-	551,844	10,881,675	5.07	-	6335	nan
Age >= 65 & NSAID	1.11	0.75	334,487	9,207,007	3.63	4.54	6304	99.03
PU & NSAID	1.32	1.07	32,089	678,218	4.73	3.83	5801	91.44
PU & antiplatelet	4.24	3.85	41,414	678,218	6.11	10.9	5943	93.38
Warfarin/DOAC & NSAID	1.39	1.18	84,101	1,915,117	4.39	4.57	6193	97.42
Warfarin/DOAC & antiplatelet	2.26	1.67	52,575	1,249,865	4.21	5.86	6068	95.32
Aspirin & other antiplatelet	1.67	1.2	36,927	1,470,315	2.51	7.15	5777	90.53
Indicators associated blood test monitoring	-	-	1,102,209	3,358,954	32.81	-	6329	nan
ACEI or loop diuretic, no blood tests	5.16	12.14	850,587	3,095,595	27.48	5.89	6303	99.00
Methotrexate and no FBC	18.64	22.73	164,502	238,042	69.11	5.05	6278	98.61
Methotrexate and no LFT	19.62	23.27	166,484	238,042	69.94	5.14	6278	98.61
Lithium and no level recording	31.47	38.44	40,664	45,456	89.46	6.93	5912	93.23
Amiodarone and no TFT	36.2	39.23	46,268	59,925	77.21	6.22	5993	94.19
Indicators associated with cautioned medication in other conditions (including heart failure, asthma and acute kidney injury)	-	-	228,587	7,594,687	3.01	-	6321	nan
Asthma & beta-blocker	1.27	1.29	185,289	6,646,586	2.79	10.24	6307	99.08
HF & NSAID	1.71	1.43	31,034	735,781	4.22	6.09	5622	88.45
CRF & NSAID	1.27	1.12	14,558	476,925	3.05	4.7	2217	87.08

Gastrointestinal (GI) Bleed Indicators¶

Age 65+, on oral NSAID without gastroprotection (GI_P3A)¶

Prescription of an oral NSAID in the previous 3 months to patients aged 65 or above who have not been co-prescribed an ulcer healing drug in the previous 3 months.

H/O peptic ulcer, on oral NSAID without gastroprotection (GI_P3B)¶

Prescription of an oral NSAID in the previous 3 months to patients with a history of peptic ulceration/gastric bleed who have not been co-prescribed an ulcer healing drug in the previous 3 months.

H/O peptic ulcer, on antiplatelet without gastroprotection (GI_P3C)¶

Prescription of an aniplatelet drug in the previous 3 months in patients with a history of peptic ulceration/gastric bleed who have not been co-prescribed an ulcer healing drug in the previous 3 months.

On OAC and oral NSAID (GI_P3D)¶

Prescription of warfarin or a DOAC in the previous 3 months and a prescription of an oral NSAID in the previous 3 months.

On OAC and antiplatelet without gastroprotection (GI_P3E)¶

Prescription of warfarin or a DOAC in combination with an antiplatelet drug in the previous 3 months without co-prescription of an ulcer-healing drug.

Note: "In combination" is defined as a co-prescription within 28 days of each other.

On aspirin and antiplatelet without gastroprotection (GI_P3F)¶

Prescription of aspirin in combination with another antiplatelet drug in the previous 3 months without co-prescription of an ulcer-healing drug.

Note: "In combination" is defined as a co-prescription within 28 days of each other.

Monitoring Indicators¶

Age 75+, on ACEI or loop, no renal function/electrolytes test (MO_P13)¶

Absence of a computer-recorded check of renal function or electrolytes in the previous 15 months in patients aged 75 or over who have been prescripted an ACEi of loop diuretic in the previous 6 months.

Methotrexate audit (MO_P15)¶

On methotrexate without recorded full blood count¶

Absence of a recorded full blood count in the previous 3 months in patients who have been receiving a methotrexate prescription for at least 3 months.

On methotrexate without recorded liver function test¶

Absence of a recorded liver function test in the previous 3 months in patients who have been receiving a methotrexate prescription for at least 3 months.

On lithium without recent lithium test (MO_P17)¶

Absence of a recorded check of lithium concentration in the previous 3 months in patients who have been receiving a lithium prescription for at least 3 months.

On amiodarone without recent thyroid function test (MO_P18)¶

Absence of a recorded thyroid function test in the previous 6 months in patients who have been receiving a lithium prescription for at least 6 months.

Other Indicators¶

Asthma and non-selective BB (AS_P3G)¶

Prescription of a non-selective beta-blocker in the previous 3 months in patients with a history of asthma.

Note: History of asthma is defined as patients with a recorded code for asthma without a more recent asthma resolved code.

Heart failure and oral NSAID (HF_P3I)¶

Prescription of an oral NSAID in the previous 3 months in patients with heart failure.

eGFR <45 and oral NSAID (KI_P3K)¶

NOTE: The results below are for TPP practices only.

Prescription of an oral NSAID in the previous 3 months to patients with an eGFR < 45.