Number of potential preventable drug related morbidity (PDRM) events by indicator and range of number of events at individual practice level
| Indicator details | No of events | No of practices with at least one event | Range of number of events at individual practice level |
|---|---|---|---|
| CHF = congestive heart failure; NSAID = non-steroidal anti = inflammatory drug; ACE = angiotensin converting enzyme; MI = myocardial infarction; COAD = chronic obstructive airways disease; INR = international normalised ratio; GI = gastrointestinal. | |||
| Outcome: GP practice or hospital contact due to CHF and/or fluid overload | 96 | 7 | 0–31 |
| Pattern of care: Use of an oral/topical NSAID for 3 months or more in a patient with hypertension and/or CHF | |||
| Outcome: Raised serum creatinine (⩾150 μmol/l) | 84 | 8 | 3–21 |
| Pattern of care: Use of an ACE inhibitor without monitoring the creatinine level before starting treatment, within 6 weeks of commencement, and at least annually thereafter | |||
| Outcome: Hyperkalaemia (potassium level ⩾5.5 mmol/l) | 61 | 8 | 2–19 |
| Pattern of care: Use of an ACE inhibitor without monitoring the potassium level before starting treatment, within 6 weeks of commencement, and at least annually thereafter | |||
| Outcome: Fall or broken bone | 61 | 8 | 2–18 |
| Pattern of care: Use of a long half life hypnotic-anxiolytic | |||
| Outcome: A second MI | 39 | 7 | 0–19 |
| Pattern of care: In the absence of any contraindication, failing to prescribe a β blocker in a patient with a history of an MI | |||
| Outcome: Dyspepsia or upper GI bleed, GI perforation, GI ulcer or anaemia | 25 | 7 | 0–7 |
| Pattern of care: Use of an oral/topical NSAID for 1 week or more in a patient with a history of peptic ulcers or GI bleeding | |||
| Outcome: GP contact or hospital admission due to worsening symptoms of CHF | 22 | 6 | 0–7 |
| Pattern of care: In the absence of any contraindication, failing to prescribe an ACE inhibitor to a patient with known CHF | |||
| Outcome: Blood dyscrasias | 21 | 5 | 0–7 |
| Pattern of care: Use of carbamazepine without a full blood count before treatment initiated and periodically during treatment | |||
| Outcome: GP practice or hospital contact due to asthma symptoms | 15 | 3 | 0–7 |
| Pattern of care: Use of an inhaled short acting bronchodilator more than once daily or at night in an asthmatic patient with no regular inhaled “preventer” therapy (corticosteroid or cromoglycate or nedocromil) | |||
| Outcome: GP or hospital contact due to an exacerbation of asthma or COAD | 15 | 6 | 0–5 |
| Pattern of care: Use of β blocker in a patient with asthma or COAD | |||
| Outcome: A minor or major haemorrhagic event | 13 | 5 | 0–4 |
| Pattern of care: Use of warfarin without monitoring the INR before initiation of treatment, on alternate days in the early days of treatment, then at longer intervals, then at least every 3 months thereafter | |||
| Outcome: Hypokalaemia (potassium level ⩽3.0 mmol/l) | 11 | 6 | 0–4 |
| Pattern of care: Use of a potassium wasting diuretic without concurrent use of a potassium supplement or concurrent use of a potassium sparing diuretic or monitoring the potassium level at least annually | |||
| Outcome: A second MI | 11 | 4 | 0–7 |
| Pattern of care: In the absence of any contraindication, failing to prescribe aspirin in a patient with a history of MI | |||
| Outcome: Oral thrush/dysphonia | 10 | 6 | 0–3 |
| Pattern of care: Use of an inhaled steroid by high dose metered dose inhaler without usage of a spacer device | |||
| Outcome: GP practice or hospital contact due to hyperthyroidism | 5 | 3 | 0–3 |
| Pattern of care: Use of a thyroid agent without monitoring the T4 or thyroid stimulating hormone within 6 weeks of initiation of treatment and at least every 12 months thereafter | |||
| Outcome: A minor or major haemorrhagic event | 5 | 3 | 0–2 |
| Pattern of care: Concurrent use of warfarin and an oral/topical NSAID without monitoring the INR within 10 days | |||
| Outcome: A minor or major haemorrhagic event | 2 | 1 | 0–2 |
| Pattern of care: Concurrent use of warfarin and an antibiotic without monitoring the INR within 5 days | |||
| Outcome: Acute urinary retention | 2 | 2 | 0–1 |
| Pattern of care: Use of an anticholinergic agent in a patient with a history or current diagnosis of benign prostatic hypertrophy | |||
| Outcome: Serum transaminase concentrations elevated to three times the upper limit of the reference range or clinical jaundice | 2 | 2 | 0–1 |
| Pattern of care: Use of a statin without monitoring the liver function before starting treatment, within 3 months of commencement and then at 6 monthly intervals thereafter | |||
| Outcome: GP or hospital contact due to a deterioration in symptoms, or an acute exacerbation, of asthma or COAD | 2 | 2 | 0–1 |
| Pattern of care: Prescribing β blocker eye drops to a patient with a history of asthma or COAD | |||
| Outcome: Drowsiness or confusion or arrhythmias or delirium or hallucinations | 2 | 1 | 0–2 |
| Pattern of care: Continued use of a previously established dose of digoxin without assessing the digoxin level in a patient presenting with any of the following symptoms: anorexia, nausea and vomiting, diarrhoea, visual disturbances, fatigue | |||
| Outcome: Dyspepsia or upper GI bleed, GI perforation, GI ulcer or anaemia | 1 | 1 | N/A |
| Pattern of care: Use of an oral corticosteroid for at least 3 months in a patient with a history or current diagnosis of peptic ulcers and/or GI bleeding | |||
| Outcome: GP practice or hospital contact due to CHF and/or heart block | 1 | 1 | N/A |
| Pattern of care: Use of digoxin in a patient with CHF, with heart block or advanced bradycardia | |||
| Outcome: Worsening of Parkinson’s disease symptoms e.g. attacks of rigidity or tremor | 1 | 1 | N/A |
| Pattern of care: Use of metoclopramide in a patient with a history of Parkinson’s disease | |||
| Outcome: Acute urinary retention | 0 | 0 | N/A |
| Pattern of care: Use of imipramine in a patient with a history or current diagnosis of bladder atony resulting from diabetes | |||
| Outcome: Anorexia or nausea and vomiting or diarrhoea or visual disturbances or fatigue or drowsiness or confusion or arrhythmias or delirium or hallucinations | 0 | 0 | N/A |
| Pattern of care: Addition of amiodarone to the treatment of a patient already prescribed digoxin without reducing the digoxin dosage by initially one third to one half and subsequent monitoring of the digoxin level | |||
| Outcome: Hyperkalaemia (potassium level ⩾5.5 mmol/l) | 0 | 0 | N/A |
| Pattern of care: Concurrent use of an ACE inhibitor and either a potassium sparing diuretic or a potassium supplement without monitoring the potassium level at least annually | |||
| Outcome: A minor or major haemorrhagic event | 0 | 0 | N/A |
| Pattern of care: Addition of amiodarone to the treatment of a patient already prescribed warfarin without reducing the warfarin dose and closely monitoring the INR | |||
| Outcome: Hospital admission due to loss of seizure control. | 0 | 0 | N/A |
| Pattern of care: Continued use of a previously established dose of phenytoin without assessing phenytoin level in a patient experiencing an altered seizure pattern | |||