Lincolnshire Integrated Care Board
Integrated Care Board
Action Planned
The ICB will add a statement to the Lincolnshire Formulary reminding users to prescribe PPIs with NSAIDs, and will highlight NICE guidelines in the Medicines Optimisation newsletter and primary care Bulletin. It will also share a case study at the Medicine Safety Network meeting and the Prescribing Forum. (AI summary)
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Dear Ms Wilkes
In the matter of inquest touching the death of the late Jonathan Paul Szczepanski – Response from Lincolnshire Integrated Care Board
I am responding on behalf of Lincolnshire ICB at the request of our Chief Executive, Mr John Turner, who I have briefed on the case and our response. I have now reviewed your request with contribution from our Medicines Optimisation team and respond to each of the points raised in the report as stated below.
1. There is a lack of local practitioner guidance on the practical implementation of the NICE NSAIDs – prescribing issues documentation.
ICB response It is long-standing accepted practice, as per NICE guidelines, that PPIs should be considered as a co-prescription with NSAIDs for at risk patients.
ICB Actions
1. The ICB will add a statement to the Lincolnshire Formulary in way of a reminder of the use of PPIs with NSAIDs.
2. The ICB will highlight the NICE guidelines in the “hot topic” article in the next Medicines Optimisation newsletter. This will also be shared in the primary care Bulletin.
3. This will be shared as a case study at the Medicine Safety Network meeting and the Prescribing Forum, including a reminder of the NICE guidelines
2. The software being used to prescribe NSAIDs did not automatically generate a specific warning flag to alert the prescriber to the considerations and risk factors in the prescription of NSAIDs (including the use of PPI).
ICB response Lincolnshire ICB has two software systems in place to assist prescribing of NSAIDs, OptimiseRx and Eclipse.
OptimiseRx has an automated alert at the time of prescribing NSAIDs. This comes up as a pop up to remind the clinician issuing the NSAID that they should consider adding a PPI to the prescription. Eclipse generates a weekly report regarding prescriptions of NSAIDs and identifies where co-prescribing of PPIs has not occurred. The practice can use this data to retrospectively review the patient record and add or change the appropriate medication. The ICB is working with all practices to highlight the importance of using these tools.
3. Where repeat prescriptions were issued on discharge of a patient from hospital back to community primary care, there was no warning on the discharge documentation to alert the prescriber to the considerations and risk factors in the prescription of NSAIDs (including the use of PPI).
ICB response At the point of discharge from hospital a list of all medications is produced and is sent to the relevant GP practice. The ICB understands that the Trust is putting in place an electronic patient record that should make this more visible. We will work with the Trust to develop systems that promote safer prescribing which will include work with the safety lead to resend a reminder of the importance of co-prescribing a PPI with NSAID, and we plan to monitor this through our Quality forum.
We are committed to working collaboratively with our relevant partners to implement changes from the lessons learnt from this case. Should you require and further information or clarification on any of the points please do not hesitate to contact me.
Your faithfully
Medical Director Lincolnshire ICB
In the matter of inquest touching the death of the late Jonathan Paul Szczepanski – Response from Lincolnshire Integrated Care Board
I am responding on behalf of Lincolnshire ICB at the request of our Chief Executive, Mr John Turner, who I have briefed on the case and our response. I have now reviewed your request with contribution from our Medicines Optimisation team and respond to each of the points raised in the report as stated below.
1. There is a lack of local practitioner guidance on the practical implementation of the NICE NSAIDs – prescribing issues documentation.
ICB response It is long-standing accepted practice, as per NICE guidelines, that PPIs should be considered as a co-prescription with NSAIDs for at risk patients.
ICB Actions
1. The ICB will add a statement to the Lincolnshire Formulary in way of a reminder of the use of PPIs with NSAIDs.
2. The ICB will highlight the NICE guidelines in the “hot topic” article in the next Medicines Optimisation newsletter. This will also be shared in the primary care Bulletin.
3. This will be shared as a case study at the Medicine Safety Network meeting and the Prescribing Forum, including a reminder of the NICE guidelines
2. The software being used to prescribe NSAIDs did not automatically generate a specific warning flag to alert the prescriber to the considerations and risk factors in the prescription of NSAIDs (including the use of PPI).
ICB response Lincolnshire ICB has two software systems in place to assist prescribing of NSAIDs, OptimiseRx and Eclipse.
OptimiseRx has an automated alert at the time of prescribing NSAIDs. This comes up as a pop up to remind the clinician issuing the NSAID that they should consider adding a PPI to the prescription. Eclipse generates a weekly report regarding prescriptions of NSAIDs and identifies where co-prescribing of PPIs has not occurred. The practice can use this data to retrospectively review the patient record and add or change the appropriate medication. The ICB is working with all practices to highlight the importance of using these tools.
3. Where repeat prescriptions were issued on discharge of a patient from hospital back to community primary care, there was no warning on the discharge documentation to alert the prescriber to the considerations and risk factors in the prescription of NSAIDs (including the use of PPI).
ICB response At the point of discharge from hospital a list of all medications is produced and is sent to the relevant GP practice. The ICB understands that the Trust is putting in place an electronic patient record that should make this more visible. We will work with the Trust to develop systems that promote safer prescribing which will include work with the safety lead to resend a reminder of the importance of co-prescribing a PPI with NSAID, and we plan to monitor this through our Quality forum.
We are committed to working collaboratively with our relevant partners to implement changes from the lessons learnt from this case. Should you require and further information or clarification on any of the points please do not hesitate to contact me.
Your faithfully
Medical Director Lincolnshire ICB