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Safe and appropriate prescribing of Gabapentoids.pdf

The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Safe and appropriate prescribing of Gabapentoids, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

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Safe and appropriate prescribing of Gabapentoids
Audit and review of current prescribing at Victoria Park Health Centre to improve the quality of structured medication reviews
Caroline Needham : Lead Pharmacist, Victoria Health Centre, part of Leicester City and Universities PCN
During discussions with the pharmacist representatives
from the three PCN member practices a plan was agreed
related to QOF Quality Improvement 22/23 - Prescribing
of drugs of dependency
The practices agreed to focus on safe prescribing of
gabapentoids and discussed two clinical scenarios to
review:
1) Renal function and dosing in accordance with BNF
guidelines
2) Women of childbearing age to ensure adequate
contraception as appropriate
Agreed PCN objective – to review and reduce prescribing
of Gabapentoids at doses outside of BNF guidelines
related to renal function as necessary
•At practice level it was decided to audit BOTH
clinical scenarios to help inform and improve our
structured medication reviews (SMRs) as well as
meet the PCN objective for the QOF Quality
Improvement audit
•My role at the practice includes being a Designated
Supervisor for two foundation pharmacists. As a
learning opportunity they would each review one
clinical scenario
•Data from the audit, clinical background related to
the safe prescribing of gabapentoids and
associated risks to be presented at the monthly
practice educational meeting
•Patients at potential risk of harm identified from
the audit would be invited for review by the
practice pharmacy team before the end of
February
•References
• MHRA (2022) Drug Safety Update volume 15, issue 9: April 2022: 3
• Digital Medicines Information Suite (2022) MedicinesComplete. Available at:
https://about.medicinescomplete.com/ (Accessed: January 18, 2023).
• Reference guide to consent for examination or treatment - gov.uk (no date) medicines complete.
Available at:
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/
file/138296/dh_103653__1_.pdf
Examples of recent SMRs which have considered gabapentoid prescribing
demonstrating learning from the polypharmacy ALS
Transgender patient identifying as male
PMH – Fibromyalgia, recent diagnosis of
ADHD
Medications include pregabalin and
sertraline. Normal renal function
No risk of pregnancy confirmed by asking if
sexually active in a way which could result in
them becoming pregnant
Outcome - in anticipation of starting ADHD
treatment the patient wanted to start to
wean dose of sertraline, therefore no change
to pregabalin dose
Female patient with chronic pain
Medications include fentanyl 100mcg/hr patch
& pregabalin 100mg three times a day. Normal
renal function, no chance of pregnancy
Outcome - agreed plan reduction in dose of
pregabalin by reducing dose by 25mg
gradually at each dose interval on a monthly
basis
Since SMR there has been two contacts with
the patient
Month one : reduced to 100mg, 75mg,100mg
Month two : 100mg, 75mg, 75mg
0 10 20 30 40 50 60 70 80 90
Total number of patients prescribed gabapentoids
Total number of those patients who are female and of child
bearing age
Gabapentoids in women of child bearing age
0
10
20
30
40
50
60
70
80
90
Number of patients
prescribed
gabapentoid in last
6 months
Number of patients
who have a creatine
clearance which
would limit dose
Number of patients
prescribed at a dose
above that indicated
by creatine
clearance
Gabapentoids and renal function
The example SMRs have allowed me to consider my approach to patient-centred
reviews. Particularly with regards to the transgender patient now identifying as
male but remaining physically able to potentially conceive, I needed to consider
how to phrase my enquiry about risk of pregnancy very carefully
The chronic pain patient was anxious about making the change but with regular
contact and a gradual approach this is going well

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Safe and appropriate prescribing of Gabapentoids.pdf

  • 1. Safe and appropriate prescribing of Gabapentoids Audit and review of current prescribing at Victoria Park Health Centre to improve the quality of structured medication reviews Caroline Needham : Lead Pharmacist, Victoria Health Centre, part of Leicester City and Universities PCN During discussions with the pharmacist representatives from the three PCN member practices a plan was agreed related to QOF Quality Improvement 22/23 - Prescribing of drugs of dependency The practices agreed to focus on safe prescribing of gabapentoids and discussed two clinical scenarios to review: 1) Renal function and dosing in accordance with BNF guidelines 2) Women of childbearing age to ensure adequate contraception as appropriate Agreed PCN objective – to review and reduce prescribing of Gabapentoids at doses outside of BNF guidelines related to renal function as necessary •At practice level it was decided to audit BOTH clinical scenarios to help inform and improve our structured medication reviews (SMRs) as well as meet the PCN objective for the QOF Quality Improvement audit •My role at the practice includes being a Designated Supervisor for two foundation pharmacists. As a learning opportunity they would each review one clinical scenario •Data from the audit, clinical background related to the safe prescribing of gabapentoids and associated risks to be presented at the monthly practice educational meeting •Patients at potential risk of harm identified from the audit would be invited for review by the practice pharmacy team before the end of February •References • MHRA (2022) Drug Safety Update volume 15, issue 9: April 2022: 3 • Digital Medicines Information Suite (2022) MedicinesComplete. Available at: https://about.medicinescomplete.com/ (Accessed: January 18, 2023). • Reference guide to consent for examination or treatment - gov.uk (no date) medicines complete. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/ file/138296/dh_103653__1_.pdf Examples of recent SMRs which have considered gabapentoid prescribing demonstrating learning from the polypharmacy ALS Transgender patient identifying as male PMH – Fibromyalgia, recent diagnosis of ADHD Medications include pregabalin and sertraline. Normal renal function No risk of pregnancy confirmed by asking if sexually active in a way which could result in them becoming pregnant Outcome - in anticipation of starting ADHD treatment the patient wanted to start to wean dose of sertraline, therefore no change to pregabalin dose Female patient with chronic pain Medications include fentanyl 100mcg/hr patch & pregabalin 100mg three times a day. Normal renal function, no chance of pregnancy Outcome - agreed plan reduction in dose of pregabalin by reducing dose by 25mg gradually at each dose interval on a monthly basis Since SMR there has been two contacts with the patient Month one : reduced to 100mg, 75mg,100mg Month two : 100mg, 75mg, 75mg 0 10 20 30 40 50 60 70 80 90 Total number of patients prescribed gabapentoids Total number of those patients who are female and of child bearing age Gabapentoids in women of child bearing age 0 10 20 30 40 50 60 70 80 90 Number of patients prescribed gabapentoid in last 6 months Number of patients who have a creatine clearance which would limit dose Number of patients prescribed at a dose above that indicated by creatine clearance Gabapentoids and renal function The example SMRs have allowed me to consider my approach to patient-centred reviews. Particularly with regards to the transgender patient now identifying as male but remaining physically able to potentially conceive, I needed to consider how to phrase my enquiry about risk of pregnancy very carefully The chronic pain patient was anxious about making the change but with regular contact and a gradual approach this is going well