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November 2019

Increase routine testing for key safety markers

General practice prescribers are being urged to standardise their approaches to routine testing and monitoring of drugs, after new data revealed a significant variation in compliance across key safety indicators both for high risk prescriptions and many routinely prescribed drugs.

The new figures, from OptimiseRx, the prescribing decision support tool used by two thirds of CCGs, suggest the need for prescribers to increase essential routine testing of clinical markers for patient harm from medications, and for more robust recording of test results into the primary care clinical system.

OptimiseRx is used by 4,000 practices in England and Wales covering 35.5 million patients. It prompts prescribers to monitor patients if evidence of routine drug monitoring recommended by RCGP safety indicators* is not found in the patient record.

Figures for 2018-19 show a mixed picture on safety adherence.

For amiodarone prescriptions, prescribers were alerted on more than 20% of occasions to the absence of a thyroid function test being recorded. Appropriate monitoring of liver function in the same patient group was better, with 16% of prescriptions having no evidence of liver function tests recorded in the previous nine months.

For patients with type 2 diabetes taking metformin, the incidence of missed - or unrecorded - serum creatinine tests within the past 12 months was 8.5%.

For the mood stabiliser lithium, monitoring was prompted for an average 3% of prescriptions where there was no evidence of lithium level test results in the previous six months.

The OptimiseRx technology is designed to help prescribers comply with local and national prescribing priorities, including the availability of more cost effective alternatives, and by providing patient-specific prescribing recommendations based on the patient's record to ensure safe and effective prescribing.

*The RCGP safety indicators cover 56 drugs associated with a risk of harm, ranging from low to extreme, and can be found in Rachel Spencer's 2014 paper in the British Journal of General Practice at