West of England AHSN Medicines Risk Stratification Tool
The medicines risk stratification tool is being developed to support the West of England AHSN to identify best practice, opportunities for improvement and supporting spread and adoption across the AHSN.
It utilises a set of prescribing indicators that have been developed as part of a programme of work to promote safer use of medicines, including prescribing, dispensing, administration and monitoring.
The purpose of the indicators are to support reductions in hospital admissions that may be associated with prescribing, to reduce the risk of avoidable medicines related harms and to quantify patients at potentially increased medicines related safety risk.
- The content is based on consideration of the medicines safety related indicators that are available in the growing number of ‘dashboards’, related information sources and data sets available.
- The RST only contains a selected number of medicines safety indicators for the purpose of supporting local focus, with input from across the AHSN on choice of indicators and content.
- This RST approach is aimed at developing and supporting collaborative based working across the AHSN on improving medication safety on RST indicators areas of local interest.
- The initial content is based on consideration of the indicators available within the ePACT2 system. There will be the option to include indicators from other information sources as this approach is developed.
- The RST does not state where best practice targets are for the indicators involved, in recognition of the fact that specific best practice positions may be dependent on local circumstances and therefore should be locally determined.
Ref Opioids Prescribing Indicators
O1 Continuous prescribing of opiates for more than 12 month
O2 High dose opioids as percentage regular opioids by all CCGs
O3 High dose opioids per 1000 patients by all CCGs
O4 Opioids - total oral morphine equivalence by CCG
O5 Anxiolytics and Hypnotics - Average Daily Quantity per item by all CCGs
O6 Prescribing of gabapentin and pregabalin (DDD) by all CCGs
O7 Prescribing of pregabalin by all CCGs
Ref Polypharmacy Indicators
IP7 Average number of unique medicines per patient
IP8 Percentage of patients prescribed 8≥ unique medicines
IP10 Percentage of patients prescribed 10≥ unique medicines
IP15 Percentage of patients prescribed 15 ≥ unique medicines
IP20 Percentage of patients prescribed 20 ≥ unique medicines
Ref Anticoagulant Indicators
IP6 Multiple prescribing of anticoagulants and antiplatelet medicine
S2 GIB02:[Increased risk of hospital admission] Prescribed NSAID + oral anticoagulant
S3 GIB03:[Increased risk of hospital admission] Prescribed an oral anticoagulant + anti-platelet without gastro-protection
Ref Gastrointestinal Bleed Risk Indicators
S1 GIB01:[Increased risk of hospital admission] Prescribed NSAID without gastro-protection
S4 GIB04:[Increased risk of hospital admission] Prescribed aspirin + anti-platelet without gastro-protection
S5 GIBCI:[Increased risk of hospital admission] Composite increased risk indicator - gastro-intestinal bleed
Ref Additional Polypharmacy Indicators
P1.85 Percentage of patients prescribed 8 or more unique medicines aged 85 and over
P2.85 Average number of unique medicines per patient aged 85 and over
P3.6 Percentage of patients with an anticholinergic burden score of 9 or more
P4 Percentage of patients prescribed two or more unique medicines likely to cause kidney injury (DAMN medicines)
P5 Percentage of patients prescribed a NSAID and one or more other unique medicines likely to cause kidney injury (DAMN medicines)
Links to useful websites
Every month, the NHS in England publishes anonymised data about the drugs prescribed by GPs. But the raw data files are large and unwieldy, with more than 700 million rows. The Open Prescribing website is making it easier for GPs, managers and everyone to explore - supporting safer, more efficient prescribing.
Please follow this link to access the website
You might find the following link also useful. It leads you to the medicines optimisation dashboard that was first launched in 2014 and since then NHS England has developed and refined the dashboard based on feedback from the people who use it.
Please follow this link to access the website
The English Prescribing dataset contains detailed information on prescriptions issued in England that have been dispensed in England, Wales, Scotland, Guernsey, Alderney, Jersey, and the Isle of Man.
The dataset combines elements of the Detailed Prescribing Information (DPI) data previously released by NHS Business Services Authority (NHSBSA) via the Information Services Portal, and the Practice Level Prescribing in England (PLP) data released by NHS Digital via their website. It is intended to replace both of those sources.
These datasets have been brought together to provide end users with a single comprehensive, consistent and accessible source of prescribing information.