National Therapeutic Indicators – How can EMIS help?

Dr Keith Burns,EMIS NUG Committee,

Broadbay Medical Practice, Stornoway

National therapeutic indicators

THE NATIONAL THERAPEUTIC INDICATORS 2012 (in order of BNF

chapter): • Proton Pump Inhibitors: DDDs per 1,000 patients per day.

Proton Pump Inhibitors: high strength PPIs as a % of all PPIs (DDDs)• Statins: Simvastatin, atorvastatin & pravastatin as a percentage of all statins

(DDD)• Ezetimibe: Ezetimibe as a percentage of ezetimibe and all statins (DDDs)• Dipyridamole MR: Dipyridamole DDD per 1,000 patients per day• High Strength Inhaled Corticosteroids: High Strength Inhaled Corticosteroids as a

percentage of all inhalers (items)• Hypnotics: Hypnotics and anxiolytics DDD per patients per day• Total Antibiotic Use: total items per 1,000 patients per day

4C Antibiotics: proportion of ‘4C antibiotics’ (fluoroquinolones,cephalosporins, co-amoxiclav and climamycin) items per 1,000 patients per day

• Quinine Use: DDDs per 1000 patients per day• Antidiabetic drugs: established oral hypoglycaemics (metformin &

sulphonylureas) as percentage of all antidiabetic drugs (DDDs)• Antimicrobial Wound Products: Antimicrobial wound products as percentage of

total wound products (items)

Main strategies

• Removal or replacement as a batch• Prompting for clinicians• Targeting in clinics

• Use of Scriptswitch were available

Some just education only

• Total antibiotic use – remove from repeats or review long term use for UTIs?

• Antidiabetic drugs• Antimicrobial wound products – possible use

of warnings if nurses prescribe using EMIS

Removal or replacement

• Ezetemibe• Dipyridamole MR• High strength PPI• Hypnotics? – difficult

• Do a search, batch print letters and then work through the EMIS numbers

Prompting for clinicians

• PPI• Statins• All of the previous ones in order to stop re-

starting• 4C antibiotics

• Use of warning messaging in EMIS

Targeting in clinics / med reviews

• PPI• High strength inhaled corticosteroids• Quinine

• Prompts on templates and regular reminders for clinicians to review.

Use of Scriptswitch

• Helping with the replacement of drugs – Dipyridamole MR

• Warning for all indicators