Information from the CQC website with regards to high- risk drugs etc .
GP mythbuster 12: Accessing medical records and carrying out clinical searches – Care Quality Commission (cqc.org.uk)
These are examples of the search categories we are currently using.
It is not a full list, and we will update it periodically.
You will need to provide assurance in line with the following areas:
- Monitoring patients prescribed DMARDs See Specialist Pharmacy Service (SPS) guidance on drug monitoring.
- Azathioprine monitoring
- Leflunomide monitoring
- Methotrexate monitoring
Also see NICE Clinical Knowledge Summary (CKS) for DMARD monitoring
- Medicines requiring monitoring: NICE CKS and specific data sheet/licensing requirements
- ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin receptor blocker) monitoring
- Aldosterone Antagonist monitoring
- Amiodarone monitoring
- Direct oral anticoagulants (DOAC) monitoring
- Lithium monitoring
- Metformin with eGFR less than 30
- Warfarin monitoring
- MHRA/Central Alerting System (CAS)/drug safety updatealerts to check provider has taken appropriate action in response
a) Single drug alerts:
b) Combination drug alerts:
- Potential missed diagnosis:
- Medicines usage:
- Number of asthmatic patients issued more than 12 Short Acting Beta 2 Agonist (SABA) inhalers in the last 12 months. See Why asthma still kills 2014.
- Prescribing gabapentinoid medicines where review is indicated.
- Prescribing benzodiazepine and ‘Z’ drugs and where frequency of issue warrants investigation.
- Prescribing a non-steroidal anti-inflammatory drug or antiplatelet to a patient aged over 70 without a proton pump inhibitor for gastrointestinal protection
- Prescribing a long acting beta agonist (LABA) inhaler to an asthmatic patient (excluding COPD) in the past 6 months with no inhaled corticosteroid prescribed
- Patients with atrial fibrillation and a recorded CHADSVASC2 score greater than or equal to:
- 1 if male
- 2 if female
with no anticoagulant prescribed
- Combined oral contraceptive pill prescribed to patients with a history of venous thromboembolism
- Medication review
- Identifying all patients who have had a medicines review in the last 3 months to assess quality of the review process (all ages and over 75 years).
- Identifying patients receiving 10 or more medicines who have no medication review recorded in the past 18 months
- Monitoring of high-risk patients with long-term conditions:
- Patients with chronic kidney disease (CKD) stage 4 or 5 who have not had a urea and electrolytes (U+E) test in the last 9 months
- Patients with diabetic retinopathy with latest HbA1c greater than 74mmol/l
- Asthmatic patients prescribed 2 or more courses of oral steroids in the last 12 months
- Hypothyroid patients who have not had a thyroid stimulating hormone (TSH) test in the last 18 months.
- We may also look at:
- Patients who have had a DNACPR or ReSPECT form completed in the last 2 years
- How patients have accessed different types of appointments in recent months.