Table 2

Practice Partner Research Network medication safety indicator descriptions, practice adherence medians and benchmarks

Indicator descriptionEligible patients (n)Median (range) (%)Benchmark (%)No of practices achieving benchmark
Avoiding potentially inappropriate treatment
 Avoidance of antibiotics within 3 days of URI26Pts with a dx of common cold, pharyngitis, or acute bronchitis in the past year* (n=7100)46 (13–92)822
 Avoidance of inappropriate medications in the elderly 27Pts ≥65 years (n=9347)99 (94–100)9912
 Avoidance of rarely appropriate medications in the elderly 27Pts ≥65 years (n=9347)96 (86–100)984
Avoiding potentially inappropriate dosing
 Allopurinol in renal dysfunction28
  • ≤200 mg/day if CrCl 20–60 ml/min, 100 mg/day if CrCl ≤20 ml/min

Pts with CrCl <60 ml/min and active rx (n=117)71 (25–100)1004
 Short-acting benzodiazepine dosing in the elderly29
  • ≤2 mg/day alprazolam, 3 mg/day lorazepam, 60 mg/day oxazepam, 15 mg/day temazepam and 0.25 mg/day triazolam

Pts ≥ 65 years and active rx (n=890)95 (84–100)998
 Digoxin ≤0.125 mg in the elderly with CHF29Pts ≥65 yrs with a dx of CHF and active rx (n=77)90 (0–100)1006
 H-2 blockers in renal dysfunction30
  • ≤1200 mg/day cimetidine, 20 mg/day famotidine, 150 mg/day nizatidine, 150 mg/day ranitidine

Pts with CrCl <50 ml/min and active rx (n=116)50 (0–100)773
Avoiding potential drug–drug interactions31
 Avoidance of macrolide antibiotics (excluding azithromycin) and digoxin22Pts on either drug (n=493)100 (100–100)10020
 Avoidance of tetracycline and digoxinPts on either drug (n=415)100 (100–100)10019§
 Avoidance of itraconazole and statinPts on either drug (n=11 935)100 (100–100)10020
 Avoidance of lithium and thiazidePts on either drug (n=7824)100 (99–100)10020
 Avoidance of methotrexate and trimethoprim22Pts on either drug (n=510)100 (100–100)10020
 Avoidance of (ACEI or ARB) with K-sparing diuretic in high-risk patients9Pts ≥65 years or CrCl <50 ml/min on either drug (n=4776)95 (87–100)994
 Avoidance of sulfonylurea and sulfamethoxazole in the elderly9Pts ≥65 years on either drug (n=760)100 (99–100)9919
Avoiding potential drug–disease interactions
 Avoidance of anticholinergics in dementia18 29Pts with dx of dementia (n=429)86 (0–100)906
 Avoidance of bupropion in epilepsy22Pts with dx of epilepsy (n=367)100 (75–100)10016
 Avoidance of metformin in renal impairment32Pts with most recent SCr ≥1.5 mg/dl (men) and SCr ≥ 1.4 mg/dl (women) (n=1336)100 (93–100)9914
 Avoidance of metoclopramide in Parkinson's disease22 24Pts with dx of Parkinson's disease (n=101)100 (50–100)10013
 Avoidance of NSAID or Cox 2 Inhibitor in CHF, HTN or renal dysfunction18Pts with dx of CHF, HTN or CrCl ≤20 ml/min (n=18 438)87 (75–95)932
 Avoidance of NSAID in peptic ulcer disease1Pts with dx of peptic ulcer disease (n=287)100 (71–100)10010
 Avoidance of thiazolidinedione in CHF33Pts with dx of CHF (n=716)96 (57–100)978
Monitoring/preventing potential adverse drug events23
 Serum creatinine monitoring18 Pts with active rx for ACEI or ARB, digoxin, diuretic** metformin, NSAID or COX2 inhibitor, or (ACEI or ARB) with K-sparing diuretic (n=19 190)80 (54–96)922
 Potassium monitoringPts with active rx for ACEI or ARB, digoxin, diuretic or (ACEI or ARB) with K-sparing diuretic (n=14 938)84 (54–97)932
 Potassium: most recent ≥ 3.5 meq/l34Pts with active rx for any thiazide and potassium measure (n=6218)96 (92–100)993
 Annual haemoglobin and platelet count1 35Pts with active rx for anti-platelet (excluding aspirin) or oral anticoagulant (n=1962)74 (23–94)893
 Annual glucose36 37Pts with active rx for antipsychotic (n=733)78 (50–100)934
 Annual weight36 37Pts with active rx for antipsychotic (n=733)96 (70–100)9710
 INR in the past 30 days35Pts with active rx for warfarin (n=841)54 (0–92)852
 Most recent INR ≤535 38Pts with active rx for warfarin and INR within 30 days (n=530)100 (92–100)10016
 Folic acid use in pts on methotrexate39Pts with active rx for methotrexate (n=100)60 (0–100)882
  • ACEI, ACE inhibitor; ARB, angiotensin receptor blocker; CHF, congestive heart failure; COX, cyclo-oxygenase; dx, diagnosis; INR, international normalised ratio; NSAID, non-steroidal anti-inflammatory drug; Pts, patients; rx, prescription; URI, upper respiratory infection.

  • * Patients with concomitant diagnosis of otitis media, pneumonia or sinusitis were excluded.

  • Barbiturates, flurazepam, meprobamate, chlorpropamide, meperidine, pentazocine, trimethobenzamide, belladonna alkaloids, propantheline, dicyclomine, hyoscyamine.

  • Chlordiazepoxide, diazepam, propoxyphene, carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol.

  • § One practice had no eligible patients.

  • Annual for all classes listed except in the past 6 months for high-risk patients ≥65 years of age or CrCl <50 ml/min on (ACEI or ARB) and K-sparing combination.

  • ** Thiazide, loop, K-sparing or spironolactone.