Table 1

Summary of the observed prevalence and the variation between practices for each prescribing safety indicator and composite indicator

NoPrescribing safety indicatorObserved
prevalence (95% CI)
Patients at risk of prescribing safety indicator (denominator)Patients triggering prescribing safety indicator (numerator)ICC (95% CI)
Unadjusted
ICC (95% CI)
Adjusted by patient-level variables
MOR (95% CI)Reliability% of practices with reliability
>0.7
Composite 1Prescribing indicators (P1–P18)9.4% (9.4 to 9.5)1 611 129151 4690.03 (0.03 to 0.03)0.01 (0.01 to 0.02)1.22 (1.2 to 1.24)0.99100.00
Composite 2Monitoring indicators (M1–M4)90.2% (89.9 to 90.5)42 87938 6710.26 (0.22 to 0.30)0.27 (0.23 to 0.31)2.86 (2.6 to 3.18)0.9799.17
Composite 3Prescribing indicators (P1–P18) excluding indicators specific for elderly or female (P11 and P13)15.5% (15.4 to 15.6)882 653136 6640.02 (0.02 to 0.03)0.01 (0.01 to 0.01)1.22 (1.2 to 1.24)0.9899.72
P1Prescribing antipsychotic with a QT-prolonging drug48.1% (47.7 to 48.6)57 99827 9230.02 (0.02 to 0.03)0.01 (0.01 to 0.02)1.21 (1.19 to 1.25)0.7770.08
P2Risperidone prescribed to a patient with dementia and without psychotic illness for more than 6 weeks90.2% (88.4 to 91.7)131011810.000.000.000.00
P3Prescribing more than one regular antipsychotic for 3 months or more, excluding clozapine augmentation41.8% (40.2 to 43.4)373515620.04 (0.02 to 0.07)0.02 (0.01 to 0.05)1.3 (1.18 to 1.52)0.260.28
P4Antipsychotic other than quetiapine, aripiprazole or clozapine prescribed to a patient with Parkinson’s disease or with Lewy body disease49.4% (45.8 to 53)7633770.04 (0.01 to 0.23)0.05 (0.01 to 0.23)1.46 (1.16 to 2.58)0.080.00
P5Selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI) prescribed with an NSAID or antiplatelet agent to a patient without gastrointestinal protection35.4% (35 to 35.8)58 32720 6530.02 (0.02 to 0.03)0.03 (0.02 to 0.03)1.35 (1.31 to 1.39)0.7870.08
P6SSRI or SNRI prescribed with a direct oral anticoagulant or warfarin3.1% (3 to 3.2)279 07386180.02 (0.01 to 0.02)0.01 (0.01 to 0.01)1.19 (1.16 to 1.23)0.9296.68
P7Prescribing citalopram, escitalopram, TCA or trazodone with QT-prolonging drugs41.9% (41.6 to 42.2)113 09747 3480.02 (0.02 to 0.03)0.02 (0.01 to 0.02)1.19 (1.16 to 1.23)0.8690.03
P8SSRI or SNRI prescribed to a patient with a history of peptic ulcer or bleeding disorders without gastroprotection38.6% (37.6 to 39.6)956736900.02 (0.01 to 0.03)0.01 (0 to 0.03)1.19 (1.11 to 1.33)0.300.00
P9Any sedative hypnotic prescribed to a patient with a history of falls12.3% (12.1 to 12.5)157 71119 3900.04 (0.03 to 0.05)0.03 (0.02 to 0.03)1.19 (1.11 to 1.33)0.9391.69
P10Benzodiazepine, Z-drug or sedating antihistamine prescribed to a patient with dementia or cognitive impairment20.2% (19.6 to 20.7)23 09946560.05 (0.04 to 0.07)0.05 (0.04 to 0.06)1.49 (1.42 to 1.58)0.7666.20
P11Benzodiazepine or Z-drug prescribed to a patient aged ≥65 years6.4% (6.3 to 6.5)524 08333 5020.05 (0.04 to 0.06)0.05 (0.04 to 0.05)1.46 (1.42 to 1.51)0.98100.00
P12Benzodiazepine or Z-drug prescribed to a patient with asthma, COPD or sleep apnoea5.7% (5.7 to 5.8)452 33825 8570.05 (0.04 to 0.06)0.04 (0.04 to 0.05)1.46 (1.41 to 1.51)0.9899.17
P13Valproic acid prescribed to a woman of childbearing potential0.2% (0.2 to 0.2)647 97912840.05 (0.03 to 0.07)0.03 (0.02 to 0.05)1.34 (1.24 to 1.47)0.9999.72
P14Prescribing lithium with an ACEi/ARB or a diuretic18.6% (17.2 to 20.1)27435110.01 (0 to 0.66)0.01 (0 to 0.58)1.16 (1.01 to 7.54)0.040.00
P15A medication with medium/high anticholinergic activity prescribed to a patient with dementia or cognitive impairment17.4% (17 to 17.9)23 09940280.03 (0.02 to 0.03)0.03 (0.02 to 0.04)1.32 (1.27 to 1.39)0.5922.71
P16Mental health-related medication with medium/high anticholinergic activity prescribed with another medication with medium/high anticholinergic activity90.6% (89.9 to 91.3)705463940.11 (0.07 to 0.16)0.12 (0.08 to 0.18)1.92 (1.69 to 2.24)0.6943.14
P17Mental health-related medication with medium/high anticholinergic activity prescribed to a patient with a history of urinary retention or benign prostatic hyperplasia10.3% (10.1 to 10.6)62 97465060.03 (0.02 to 0.03)0.01 (0.01 to 0.01)1.18 (1.13 to 1.23)0.7973.41
P18Four or more psychotropics prescribed to a patient for more than 3 months41.7% (41.1 to 42.3)24 00510 0110.03 (0.03 to 0.04)0.03 (0.02 to 0.04)1.35 (1.3 to 1.41)0.6639.28
M1Antipsychotic prescribed for at least 12 months without monitoring glucose, weight or lipid profile within the previous year91.6% (91.3 to 91.9)41 25337 7910.42 (0.37 to 0.47)0.43 (0.38 to 0.48)4.53 (3.89 to 5.36)0.9999.45
M1aAntipsychotic prescribed for at least 12 months without monitoring glucose within the previous year83.6% (83.2 to 83.9)41 25334 467
M1bAntipsychotic prescribed for at least 12 months without monitoring weight within the previous year54.9% (54.4 to 55.4)41 25322 657
M1cAntipsychotic prescribed for at least 12 months without monitoring lipid profile within the previous year61.9% (61.5 to 62.4)41 25325 549
M2Initiation of haloperidol without monitoring ECG at baseline92.6% (89.6 to 94.9)4043740.45 (0.14 to 0.8)0.51 (0.2 to 0.82)5.91 (2.37 to 39.12)0.4424.02
M3Prescribing lithium without monitoring lithium plasma levels within the previous 6 months or within the last 3 months if the patient is aged ≥65 years or has a diagnosis of renal impairment or during the first year of treatment24.3% (22.7 to 26)26136350.24 (0.19 to 0.31)0.25 (0.19 to 0.32)2.74 (2.34 to 3.32)0.6642.24
M3aPrescribing lithium without monitoring lithium plasma levels within the previous 6 months18.6% (17.1 to 20.2)2525470
M3bPrescribing lithium without monitoring lithium plasma within the last 3 months if the patient is aged ≥65 years29.1% (24.9 to 33.5)451131
M3cPrescribing lithium without monitoring lithium plasma levels within the last 3 months if the patient has a diagnosis of renal impairment38.7% (32.1 to 45.6)21282
M3dPrescribing lithium without monitoring lithium plasma levels within the last 3 months during the first year of treatment30.6% (26.2 to 35.3)415127
M4Lithium prescribed for at least 6 months without monitoring U&Es or thyroid function within the last 6 months33.5% (31.7 to 35.4)25258460.17 (0.12 to 0.23)0.17 (0.12 to 0.23)2.18 (1.9 to 2.58)0.5517.58
M4aLithium prescribed for at least 6 months without monitoring U&Es within the last 6 months21.4% (19.8 to 23)2525539
M4bLithium prescribed for at least 6 months without monitoring thyroid function within the last 6 months30.5% (28.7 to 32.4)2525771
  • ACEi, ACE inhibitor; ARB, angiotensin receptor blocker; COPD, chronic obstructive pulmonary disease; ICC, intraclass correlation coefficient; MOR, median OR; NSAID, non-steroidal anti-inflammatory drug; TCA, tricyclic antidepressant; U&E, urea and electrolytes.