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Criteria |
Points |
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High risk medicines - anticoagulation audit |
On the day of the declaration, contractors must have implemented, into their day-to-day practice, the findings and recommendations from the 2017 Specialist Pharmacy Service clinical audit on anticoagulants, which are included in the revised audit of anticoagulants. The pharmacy must then complete the revised audit within the PQS guidance found at: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-quality-paymentsscheme/pqs/, including notifying the patient’s GP where concerns are identified, sharing their anonymised data with NHS England and NHS Improvement, and incorporating any learning from the audit into future practice.
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Band 1 = 0.50 Band 2 = 6.67 Band 3 = 8.33 Band 4 = 10 Band 5 = 11.67 Band 6 = 13.33 |
The points allocation for meeting the Medicines Safety and Optimisation Domain ranges from 0.50 to 13.33 and will be dependent on your total prescription volume for 2020/2021. Each point will be worth between £67.75 and £135.50 and so a contractor can earn between £33.88 and £1806.22
The aim of this quality criterion is to reduce preventable patient harm from oral anticoagulant medicines and to embed the actions, recommendations and learning from the audit which will be undertaken in clinical practice.
The Specialist Pharmacy Service 2017/18 anticoagulant audit was completed by many pharmacy contractors and since then several national medicine safety indicators involving anticoagulants have been published.
During the early stages of the COVID-19 pandemic, NHSE&I issued guidance on switching patients from warfarin to a DOAC to reduce the need for regular INR monitoring and there were occasional incidents reported where patients were receiving both warfarin and a DOAC concurrently. Pharmacists should be updating records promptly to ensure a safe transition between therapies and that discontinued treatments are not inadvertently re-ordered.
The improvement areas identified in the 2017 audit are:
- Referral and follow up of patients co-prescribed other medicines which can increase the risk of bleeding as identified in the medicine safety indicators
- Provision of oral anticoagulant alert cards to all patients requiring them
- Supporting patient knowledge about potential interactions with other medicines (basic information about anticoagulation may be particularly needed by patients taking DOAC).
The audit for this year’s PQS is designed to address these recommendations
The audit must be carried out over two weeks with a minimum of 15 patients or four weeks if 15 patients are not achieved within two weeks, and there must be a follow up of any patient that is referred to their prescriber to identify what actions were taken. A record should be made of the start and end date of the review as this information is required in the declaration made on the MYS application.
Contractors must have completed the anticoagulant audit by the day of their declaration. The information that needs to be submitted to NHS England and NHS Improvement is included in the audit document and must be reported using the NHSBSA SNAP survey via the MYS application before the PQS declaration is made.
Where a prescriber has been contacted regarding anticoagulant concerns, any subsequent actions must be followed up and documented in the patient’s PMR to ensure all necessary corrective actions have been taken. These actions should be recorded on the audit data collection tool.
The pharmacist or a competent member of staff should discuss the anticoagulant medicine with the patient or representative to help ensure safe and effective use. Attempts should be made for this discussion to occur with all patients, including patients who have their medication delivered, or patients who live in a care home. It may be appropriate to speak to an identified patient representative, family member or member of care staff.
The online portal to record data will be available on 1 October 2021.
The audit data collection form and associated information on the previous 2017 audit and recommendations from the Specialist Pharmacy Service can be found as Appendix 14 (page 62) in the full NHS Pharmacy Quality Scheme Guidance 2021/22