Table 2

Number of potential preventable drug related morbidity (PDRM) events by indicator and range of number of events at individual practice level

Indicator detailsNo of eventsNo of practices with at least one eventRange 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 overload9670–31
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)8483–21
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)6182–19
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 bone6182–18
Pattern of care: Use of a long half life hypnotic-anxiolytic
Outcome: A second MI3970–19
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 anaemia2570–7
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 CHF2260–7
Pattern of care: In the absence of any contraindication, failing to prescribe an ACE inhibitor to a patient with known CHF
Outcome: Blood dyscrasias2150–7
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 symptoms1530–7
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 COAD1560–5
Pattern of care: Use of β blocker in a patient with asthma or COAD
Outcome: A minor or major haemorrhagic event1350–4
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)1160–4
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 MI1140–7
Pattern of care: In the absence of any contraindication, failing to prescribe aspirin in a patient with a history of MI
Outcome: Oral thrush/dysphonia1060–3
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 hyperthyroidism530–3
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 event530–2
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 event210–2
Pattern of care: Concurrent use of warfarin and an antibiotic without monitoring the INR within 5 days
Outcome: Acute urinary retention220–1
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 jaundice220–1
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 COAD220–1
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 hallucinations210–2
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 anaemia11N/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 block11N/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 tremor11N/A
Pattern of care: Use of metoclopramide in a patient with a history of Parkinson’s disease
Outcome: Acute urinary retention00N/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 hallucinations00N/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)00N/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 event00N/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.00N/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