No | Prescribing safety indicator | Observed 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 1 | Prescribing indicators (P1–P18) | 9.4% (9.4 to 9.5) | 1 611 129 | 151 469 | 0.03 (0.03 to 0.03) | 0.01 (0.01 to 0.02) | 1.22 (1.2 to 1.24) | 0.99 | 100.00 |
Composite 2 | Monitoring indicators (M1–M4) | 90.2% (89.9 to 90.5) | 42 879 | 38 671 | 0.26 (0.22 to 0.30) | 0.27 (0.23 to 0.31) | 2.86 (2.6 to 3.18) | 0.97 | 99.17 |
Composite 3 | Prescribing indicators (P1–P18) excluding indicators specific for elderly or female (P11 and P13) | 15.5% (15.4 to 15.6) | 882 653 | 136 664 | 0.02 (0.02 to 0.03) | 0.01 (0.01 to 0.01) | 1.22 (1.2 to 1.24) | 0.98 | 99.72 |
P1 | Prescribing antipsychotic with a QT-prolonging drug | 48.1% (47.7 to 48.6) | 57 998 | 27 923 | 0.02 (0.02 to 0.03) | 0.01 (0.01 to 0.02) | 1.21 (1.19 to 1.25) | 0.77 | 70.08 |
P2 | Risperidone prescribed to a patient with dementia and without psychotic illness for more than 6 weeks | 90.2% (88.4 to 91.7) | 1310 | 1181 | 0.00 | 0.00 | 0.00 | 0.00 | |
P3 | Prescribing more than one regular antipsychotic for 3 months or more, excluding clozapine augmentation | 41.8% (40.2 to 43.4) | 3735 | 1562 | 0.04 (0.02 to 0.07) | 0.02 (0.01 to 0.05) | 1.3 (1.18 to 1.52) | 0.26 | 0.28 |
P4 | Antipsychotic other than quetiapine, aripiprazole or clozapine prescribed to a patient with Parkinson’s disease or with Lewy body disease | 49.4% (45.8 to 53) | 763 | 377 | 0.04 (0.01 to 0.23) | 0.05 (0.01 to 0.23) | 1.46 (1.16 to 2.58) | 0.08 | 0.00 |
P5 | Selective serotonin reuptake inhibitor (SSRI) or serotonin–norepinephrine reuptake inhibitor (SNRI) prescribed with an NSAID or antiplatelet agent to a patient without gastrointestinal protection | 35.4% (35 to 35.8) | 58 327 | 20 653 | 0.02 (0.02 to 0.03) | 0.03 (0.02 to 0.03) | 1.35 (1.31 to 1.39) | 0.78 | 70.08 |
P6 | SSRI or SNRI prescribed with a direct oral anticoagulant or warfarin | 3.1% (3 to 3.2) | 279 073 | 8618 | 0.02 (0.01 to 0.02) | 0.01 (0.01 to 0.01) | 1.19 (1.16 to 1.23) | 0.92 | 96.68 |
P7 | Prescribing citalopram, escitalopram, TCA or trazodone with QT-prolonging drugs | 41.9% (41.6 to 42.2) | 113 097 | 47 348 | 0.02 (0.02 to 0.03) | 0.02 (0.01 to 0.02) | 1.19 (1.16 to 1.23) | 0.86 | 90.03 |
P8 | SSRI or SNRI prescribed to a patient with a history of peptic ulcer or bleeding disorders without gastroprotection | 38.6% (37.6 to 39.6) | 9567 | 3690 | 0.02 (0.01 to 0.03) | 0.01 (0 to 0.03) | 1.19 (1.11 to 1.33) | 0.30 | 0.00 |
P9 | Any sedative hypnotic prescribed to a patient with a history of falls | 12.3% (12.1 to 12.5) | 157 711 | 19 390 | 0.04 (0.03 to 0.05) | 0.03 (0.02 to 0.03) | 1.19 (1.11 to 1.33) | 0.93 | 91.69 |
P10 | Benzodiazepine, Z-drug or sedating antihistamine prescribed to a patient with dementia or cognitive impairment | 20.2% (19.6 to 20.7) | 23 099 | 4656 | 0.05 (0.04 to 0.07) | 0.05 (0.04 to 0.06) | 1.49 (1.42 to 1.58) | 0.76 | 66.20 |
P11 | Benzodiazepine or Z-drug prescribed to a patient aged ≥65 years | 6.4% (6.3 to 6.5) | 524 083 | 33 502 | 0.05 (0.04 to 0.06) | 0.05 (0.04 to 0.05) | 1.46 (1.42 to 1.51) | 0.98 | 100.00 |
P12 | Benzodiazepine or Z-drug prescribed to a patient with asthma, COPD or sleep apnoea | 5.7% (5.7 to 5.8) | 452 338 | 25 857 | 0.05 (0.04 to 0.06) | 0.04 (0.04 to 0.05) | 1.46 (1.41 to 1.51) | 0.98 | 99.17 |
P13 | Valproic acid prescribed to a woman of childbearing potential | 0.2% (0.2 to 0.2) | 647 979 | 1284 | 0.05 (0.03 to 0.07) | 0.03 (0.02 to 0.05) | 1.34 (1.24 to 1.47) | 0.99 | 99.72 |
P14 | Prescribing lithium with an ACEi/ARB or a diuretic | 18.6% (17.2 to 20.1) | 2743 | 511 | 0.01 (0 to 0.66) | 0.01 (0 to 0.58) | 1.16 (1.01 to 7.54) | 0.04 | 0.00 |
P15 | A medication with medium/high anticholinergic activity prescribed to a patient with dementia or cognitive impairment | 17.4% (17 to 17.9) | 23 099 | 4028 | 0.03 (0.02 to 0.03) | 0.03 (0.02 to 0.04) | 1.32 (1.27 to 1.39) | 0.59 | 22.71 |
P16 | Mental health-related medication with medium/high anticholinergic activity prescribed with another medication with medium/high anticholinergic activity | 90.6% (89.9 to 91.3) | 7054 | 6394 | 0.11 (0.07 to 0.16) | 0.12 (0.08 to 0.18) | 1.92 (1.69 to 2.24) | 0.69 | 43.14 |
P17 | Mental health-related medication with medium/high anticholinergic activity prescribed to a patient with a history of urinary retention or benign prostatic hyperplasia | 10.3% (10.1 to 10.6) | 62 974 | 6506 | 0.03 (0.02 to 0.03) | 0.01 (0.01 to 0.01) | 1.18 (1.13 to 1.23) | 0.79 | 73.41 |
P18 | Four or more psychotropics prescribed to a patient for more than 3 months | 41.7% (41.1 to 42.3) | 24 005 | 10 011 | 0.03 (0.03 to 0.04) | 0.03 (0.02 to 0.04) | 1.35 (1.3 to 1.41) | 0.66 | 39.28 |
M1 | Antipsychotic prescribed for at least 12 months without monitoring glucose, weight or lipid profile within the previous year | 91.6% (91.3 to 91.9) | 41 253 | 37 791 | 0.42 (0.37 to 0.47) | 0.43 (0.38 to 0.48) | 4.53 (3.89 to 5.36) | 0.99 | 99.45 |
M1a | Antipsychotic prescribed for at least 12 months without monitoring glucose within the previous year | 83.6% (83.2 to 83.9) | 41 253 | 34 467 | |||||
M1b | Antipsychotic prescribed for at least 12 months without monitoring weight within the previous year | 54.9% (54.4 to 55.4) | 41 253 | 22 657 | |||||
M1c | Antipsychotic prescribed for at least 12 months without monitoring lipid profile within the previous year | 61.9% (61.5 to 62.4) | 41 253 | 25 549 | |||||
M2 | Initiation of haloperidol without monitoring ECG at baseline | 92.6% (89.6 to 94.9) | 404 | 374 | 0.45 (0.14 to 0.8) | 0.51 (0.2 to 0.82) | 5.91 (2.37 to 39.12) | 0.44 | 24.02 |
M3 | Prescribing 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 treatment | 24.3% (22.7 to 26) | 2613 | 635 | 0.24 (0.19 to 0.31) | 0.25 (0.19 to 0.32) | 2.74 (2.34 to 3.32) | 0.66 | 42.24 |
M3a | Prescribing lithium without monitoring lithium plasma levels within the previous 6 months | 18.6% (17.1 to 20.2) | 2525 | 470 | |||||
M3b | Prescribing lithium without monitoring lithium plasma within the last 3 months if the patient is aged ≥65 years | 29.1% (24.9 to 33.5) | 451 | 131 | |||||
M3c | Prescribing lithium without monitoring lithium plasma levels within the last 3 months if the patient has a diagnosis of renal impairment | 38.7% (32.1 to 45.6) | 212 | 82 | |||||
M3d | Prescribing lithium without monitoring lithium plasma levels within the last 3 months during the first year of treatment | 30.6% (26.2 to 35.3) | 415 | 127 | |||||
M4 | Lithium prescribed for at least 6 months without monitoring U&Es or thyroid function within the last 6 months | 33.5% (31.7 to 35.4) | 2525 | 846 | 0.17 (0.12 to 0.23) | 0.17 (0.12 to 0.23) | 2.18 (1.9 to 2.58) | 0.55 | 17.58 |
M4a | Lithium prescribed for at least 6 months without monitoring U&Es within the last 6 months | 21.4% (19.8 to 23) | 2525 | 539 | |||||
M4b | Lithium prescribed for at least 6 months without monitoring thyroid function within the last 6 months | 30.5% (28.7 to 32.4) | 2525 | 771 |
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.