OpenSAFELY PINCER Monthly Dashboard: Changes in English medication safety indicators throughout the COVID-19 pandemic
- Description
- 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 measures. The purpose of this notebook is observe changes in adherence to each of the PINCER measures at the practice level during the pandemic. This analysis is run on data for patients registered at a TPP practice. This covers 40% of the population of England. For details on the results presented here, please refer to the main report or to the accompanying preprint linked below.
- Authors
- Louis Fisher, Lisa EM Hopcroft , Sarah Rodgers , James Barrett, Kerry Oliver , Anthony J Avery, Dai Evans, Helen Curtis, Richard Croker, Orla Macdonald, Jessica Morley, Amir Mehrkar, Sebastian Bacon, Simon Davy, Iain Dillingham, David Evans, George Hickman, Peter Inglesby, Caroline E Morton, Becky Smith, Tom Ward, William Hulme, Amelia Green, Jon Massey, Alex J Walker, Christopher Bates, Jonathan Cockburn, John Parry, Frank Hester, Sam Harper, Shaun O’Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Ben Goldacre, Brian MacKenna
- Contact
- Get in touch and tell us how you use this report or new features you'd like to see: team@opensafely.org
- First published
- 22 May 2023
- Last released
- 29 May 2023
- Links
This report accompanies this report describing practice level changes in adherence to PINCER indicators of prescription and medication monitoring throughout the COVID-19 pandemic. This version includes data from the EHR provider TPP only and will be updated regularly. For a more detailed analysis please see the report linked above or the accompanying paper, also linked above.
Background¶
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, practice level monthly rates of hazardous prescribing are calculated, ranked and used to calculate deciles of activity, which are represented as decile charts.
The 13 PINCER measures include:
- Gastrointestinal (GI) Bleed Indicators
- Age 65+, on oral NSAID without gastroprotection (GI_P3A)
- H/O peptic ulcer, on oral NSAID without gastroprotection (GI_P3B)
- H/O peptic ulcer, on OAC without gastroprotection (GI_P3C)
- On OAC and oral NSAID (GI_P3D)
- On OAC and antiplatelet without gastroprotection (GI_P3E)
- On aspirin and antiplatelet without gastroprotection (GI_P3F)
- Monitoring Indicators
- Other Indicators
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 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.
H/O peptic ulcer, on OAC without gastroprotection (GI_P3C)¶
Prescription of an aniplatelet drug in the previous 3 months in patients with a history of peptic ulceration/gatric bleed.
On OAC and oral NSAID (GI_P3D)¶
Prescription of warfarin or a DOAC in the previous 3 months and a preascription 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)¶
Prescription of an oral NSAID in the previous 3 months to patients with an eGFR < 45.
