This report accompanies this report describing practice level changes in adherence to PINCER indicators of prescription and medication monitoring throughout the COVID-19 pandemic. This version includes data from the EHR provider TPP only and will be updated regularly. For a more detailed analysis please see the report linked above or the accompanying paper, also linked above.
Pharmacist-led information technology intervention (PINCER) is an effective way to reduce errors in prescription and medication monitoring which are responsible for a large proportion of adverse drug events. This is achieved through the monitoring of 13 PINCER indicators.
The purpose of this notebook is to describe practice level changes in adherence to each of the PINCER indicators throughout the COVID-19 pandemic. For each indicator, practice level monthly rates of hazardous prescribing are calculated, ranked and used to calculate deciles of activity, which are represented as decile charts.
The 13 PINCER measures include:
Prescription of an oral NSAID in the previous 3 months to patients aged 65 or above who have been co-prescribed an ulcer healing drug in the previous 3 months.
Prescription of an oral NSAID in the previous 3 months to patients with a history of peptic ulceration/gastric bleed.
Prescription of an aniplatelet drug in the previous 3 months in patients with a history of peptic ulceration/gatric bleed.
Prescription of warfarin or a DOAC in the previous 3 months and a preascription of an oral NSAID in the previous 3 months.
Prescription of warfarin or a DOAC in combination with an antiplatelet drug in the previous 3 months without co-prescription of an ulcer-healing drug.
Note: "In combination" is defined as a co-prescription within 28 days of each other.
Prescription of aspirin in combination with another antiplatelet drug in the previous 3 months without co-prescription of an ulcer-healing drug.
Note: "In combination" is defined as a co-prescription within 28 days of each other.
Absence of a computer-recorded check of renal function or electrolytes in the previous 15 months in patients aged 75 or over who have been prescripted an ACEi of loop diuretic in the previous 6 months.
Absence of a recorded full blood count in the previous 3 months in patients who have been receiving a methotrexate prescription for at least 3 months.
Absence of a recorded liver function test in the previous 3 months in patients who have been receiving a methotrexate prescription for at least 3 months.
Absence of a recorded check of lithium concentration in the previous 3 months in patients who have been receiving a lithium prescription for at least 3 months.
Absence of a recorded thyroid function test in the previous 6 months in patients who have been receiving a lithium prescription for at least 6 months.
Prescription of a non-selective beta-blocker in the previous 3 months in patients with a history of asthma.
Note: History of asthma is defined as patients with a recorded code for asthma without a more recent asthma resolved code.
Prescription of an oral NSAID in the previous 3 months in patients with heart failure.
Prescription of an oral NSAID in the previous 3 months to patients with an eGFR < 45.
