1. National Therapeutic Indicators – How can EMIS help? Dr Keith Burns, EMIS NUG Committee, Broadbay Medical Practice, Stornoway

2. National therapeutic indicators

3. THE NATIONAL THERAPEUTIC INDICATORS 2012 (in order of BNF chapter): Proton Pump Inhibitors: DDDs per 1,000 patients per day. Proton Pump Inhibitors: high strength PPIs as a % of all PPIs (DDDs) Statins: Simvastatin, atorvastatin & pravastatin as a percentage of all statins (DDD) Ezetimibe: Ezetimibe as a percentage of ezetimibe and all statins (DDDs) Dipyridamole MR: Dipyridamole DDD per 1,000 patients per day High Strength Inhaled Corticosteroids: High Strength Inhaled Corticosteroids as a percentage of all inhalers (items) Hypnotics: Hypnotics and anxiolytics DDD per patients per day Total Antibiotic Use: total items per 1,000 patients per day 4C Antibiotics: proportion of ‘4C antibiotics’ (fluoroquinolones,cephalosporins, co-amoxiclav and climamycin) items per 1,000 patients per day Quinine Use: DDDs per 1000 patients per day Antidiabetic drugs: established oral hypoglycaemics (metformin & sulphonylureas) as percentage of all antidiabetic drugs (DDDs) Antimicrobial Wound Products: Antimicrobial wound products as percentage of total wound products (items)

4. Main strategies Removal or replacement as a batch Prompting for clinicians Targeting in clinics Use of Scriptswitch were available

5. Some just education only Total antibiotic use – remove from repeats or review long term use for UTIs? Antidiabetic drugs Antimicrobial wound products – possible use of warnings if nurses prescribe using EMIS

6. Removal or replacement Ezetemibe Dipyridamole MR High strength PPI Hypnotics? – difficult Do a search, batch print letters and then work through the EMIS numbers

7. Prompting for clinicians PPI Statins All of the previous ones in order to stop re- starting 4C antibiotics Use of warning messaging in EMIS

8. Targeting in clinics / med reviews PPI High strength inhaled corticosteroids Quinine Prompts on templates and regular reminders for clinicians to review.

9. Use of Scriptswitch Helping with the replacement of drugs – Dipyridamole MR Warning for all indicators