Safe use of medicines Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Transcription

1 East & outh East England pecialist Pharmacy ervices East of England, London, outh Central & outh East Coast Community Pharmacies Anytown Dec 2010 Dear Colleague afe use of medicines Non-teroidal Anti-Inflammatory Drugs (NAIDs) NAIDs are effective and widely used treatments for pain and inflammation, but they are also known to occasionally cause serious side effects such as gastro-intestinal bleeding, raised blood pressure, fluid retention and renal problems. NAIDs have been identified as a major cause of preventable hospital admissions, and admissions data for the outh East confirm that this remains an important patient safety issue. Problems include poor adherence to gastro-protection, inadvertent double dosing with other non-prescribed NAIDs and insufficient renal monitoring. The Anytown GP Commissioning Consortium agreed to support a local community pharmacy initiative to help ensure safe use of NAIDs. This involves a targeted Medicines Use Review (MUR) for people prescribed regular NAIDs. The target MUR would focus on appropriate gastroprotection, information about concurrent use of non-prescription pain relief and other safety checks. Much of this will already be in place when you conduct MURs for people taking NAIDs, but MURs for this particular group are wanted by local GPs and we intend to collect information about these MURs to demonstrate outcomes and link this to resource issues eg possible prevention of hospital admissions. Information about the project has been produced for display in pharmacies and this can also be given to patients collecting prescriptions for NAIDs. If you would like any more information about these projects please contact carina.livingstone@westsussexpct.nhs.uk or. Best wishes Yours faithfully 1

2 Oral NAID safety check (MUR) 1) Regular oral NAID use with inadequate gastro-protection All patients* collecting prescriptions for oral NAIDs including coxibs regularly for at least 3 months (BNF chapter ) Quantity indicates taking at least 3 days each week No proton pump inhibitor/other gastro-protection co-prescribed OR proton pump inhibitor not being ordered/collected even though on repeat prescription list Prescription intervention MUR tandard MUR 1-3 months later to confirm gastro-protection (NB This follow-up standard MUR has been agreed for a pilot period of 6 months) If MUR not possible eg patient does not collect own prescription or refuses MUR Notify GP practice that MUR was not possible but potential GI concern (template letter A) * NICE advises co-prescription of PPI for all patients with osteoarthritis or rheumatoid arthritis and people over 45 with chronic low back pain _effects/people_at_increased_risk ) Older people Patients aged over 55 Collecting prescriptions for oral NAIDs including coxibs regularly for at least 3 months (BNF chapter ) Quantity indicates taking at least 3 days each week Proton pump inhibitor co- prescribed and quantity indicates good adherence tandard MUR What is the difference between standard MURs and prescription interventions MURs? There is only one MUR service but the trigger for service provision is different. The prescription intervention is triggered by an issue that arises when dispensing a prescription (eg poor adherence with gastroprotection); the standard MUR is a routine review 2

3 Key aspects of oral NAID target MUR - patients regularly prescribed an NAID or coxib (ie for 3 months of more) Does the patient know why they are using the medicine? What s the patients understanding of the purpose of NAID treatment eg general pain relief, muscle pain, osteoarthritis, headache, gout? Find out if being managed by a specialist or there is any specialist recommendation for regular or high dose NAID (eg patients with rheumatoid arthritis or ankylosing spondylitis). Does the patient use the medicine as prescribed? What dose do they take and how often? How effective do they find it? Unless other specialist advice, patients should take the lowest effective dose for the shortest possible time. Can they manage their symptoms with occasional use or lower dose rather than regular use? ide effects Have they ever had any stomach ulcer problems or bad indigestion? * Co-prescription of gastro-protection is advised for regular users of both traditional oral NAIDs and coxibs. Reinforce the importance of taking their PPI to prevent stomach problems or refer if not prescribed. NAID patients who take other medicines such as low dose aspirin, RIs, etc will be at even greater risk if adherence to gastroprotection is poor. * Advise on smoking cessation and alcohol consumption as appropriate: heavy smokers and drinkers are at increased risk of GI problems. * For older NAID patients particularly eg age 70, renal function tests should be done ask patients if they remember having any blood tests in the last 12 months. If not, include this on the MUR form and notify GP/practice nurse (template letter B). More information provided on use of medicine Do they use any over the counter products? Explain that is important not to buy any pain killers without checking whether they are okay to take with their medicines. Unwittingly taking two NAIDs has resulted in serious harm to patients. Essential background for pharmacies providing this service: MeReC Extra, Issue 30: Cardiovascular and gastrointestinal safety of NAIDs 3

4 THI DATA COLLECTION FORM CAN BE PRINTED OR PREFERABLY COMPLETED ON-LINE UING THE LINK BELOW Date: Pharmacy name/stamp: Regular NAID prescribed name of drug: Patient age in years: Gastro-protection co-prescribed name of drug or none: Gastro-protection collected regularly? MUR done for patient on this visit to the pharmacy? If no MUR done, was GP practice notified of potential GI concern? (If no MUR done survey finished) Only complete the following questions if the patient had an MUR (any type) on this visit to the pharmacy Type of MUR Prescription intervention/tandard MUR/ MUR follow-up (gastro-protection) Referred for gastro-protection? Adherence discussion re gastro-protection? Confirmed understanding re co-administration of OTC pain killers? Referred for renal function check? Other advice given to patient or prescriber about NAID use or choice of agent? Yes please comment below / no moking status? smoker/non-smoker Any other information/issues 4

5 afe use of medicines NAIDs Template letter A Pharmacy Address: GP Name: urgery Address: Date Dear Dr NAID safety gastro-protection Patient Name: Date of Birth: Patient Address: Our pharmacy records show this patient is regularly prescribed an NAID or coxib, but has no gastro-protection prescribed. I would be grateful if you could review ongoing NAID treatment and whether a gastro-protective agent is necessary. (Locally preferred gastro-protective agents are omeprazole or lansoprazole.) Best wishes Yours sincerely 5

6 afe use of medicines NAIDs Template letter B Pharmacy Address: GP Name: urgery Address: Date Dear Dr/Practice nurse NAID safety renal function Patient Name: Date of Birth: Patient Address: Our pharmacy records show this patient is regularly prescribed an NAID or coxib and is aged over 70. However, the patient is unsure whether renal function tests have been done in the last year. I would be grateful if you could review on-going NAID treatment and whether any renal function check is necessary. Best wishes Yours sincerely 6