Identifier | Indicator | Overall panel median Consensus | |
---|---|---|---|
A: Cardiovascular and respiratory disease | |||
A1(a)a | Prescription of a beta-blockerto a patient with asthma | 5 | Equivocal |
A1(b)a | Prescription of a non-cardioselective beta-blocker to a patient with asthma | 6 | Disagreement |
A1(c)a,b | Prescription of a beta-blockerto a patient with asthma (excluding patients who also have a cardiac condition) | 8 | Agreement |
A2 | Prescription of a nitrate to a patient with aortic stenosis | 3 | Agreement |
A3 | Prescription of short-acting nifedipine in an older person (>65 years) (excluding patients with Raynaud's disease) | 6 | Disagreement |
A3Xb,c | Prescription of short-acting nifedipine (excluding patients with Raynaud's disease) | 7 | Agreement |
A4(a)a | In an older person (>65 years), prescription of digoxin at a dose of >125 μg daily | 7 | Equivocal |
A4(b)a,b | In a patient with renal impairment, prescription of digoxin at a dose > 125 μg daily (for example, CKD 3 or worse) | 7 | Agreement |
A5b | Prescription of digoxin at a dose of > 125 μg daily for a patient with heart failure who is in sinus rhythm | 8 | Agreement |
A6b | Prescription of diltiazem orverapamil in a patient with heart failure | 8 | Agreement |
A7b | In an older patient (>65 years), prescription of aspirin at a dose >75 mg daily | 7 | Agreement |
A7Xb,c | In an older patient (>65 years), prescription of aspirin at a dose >75 mg daily for ≥1 month | 8 | Agreement |
A8 | In a patient with heart failure, the prescription of a high-sodium content drug | 3 | Equivocal |
A9(a)a | In an older patient (>65 years) with an arrhythmia, the prescription of a tricyclic antidepressant | 4 | Equivocal |
A9(b)a | In an older patient (>65 years) with a cardiac conductive abnormality, the prescription of a tricyclic antidepressant | 4 | Equivocal |
A10 | In a patient with a history of gout, the prescription of a thiazide diuretic | 3 | Agreement |
A11b | The prescription of a long-acting beta-2 agonist inhaler to a patient with asthma who is not also using an inhaled corticosteroid | 8 | Agreement |
B: Central nervous system (including analgesics) | |||
B1(a)a,b | Prescription of aspirin to a child aged ≤16 years | 9 | Agreement |
B1(b)a,b | Prescription of aspirin to a child aged ≤16 years, where the child does not have Kawasaki's disease | 9 | Agreement |
B2 | In a patient with epilepsy, the prescription of a drug that may lower the seizure threshold | 3 | Agreement |
B3(a)a,b | In a patient with Parkinson's disease, the prescription of metoclopramide | 8 | Agreement |
B3(b)a,b | In a patient with Parkinson's disease, the prescription of prochlorperazine | 8 | Agreement |
B4(a)a | In an older person (>65 years) the prescription of a benzodiazepine on a long-term basis (that is, >1 month) | 4.5 | Equivocal |
B4(a)Xa,c | In an older person (>65 years) the prescription of a benzodiazepine or Z-drug on a long-term basis (that is, >1 month) | 4.5 | Disagreement |
B4(b)a,b | In an older person (>65 years) who is not receiving benzodiazepines on a long-term basis, the prescription of a benzodiazepine for >21 days | 8 | Agreement |
B4(b)Xa,b,c | In an older person (>65 years) who is not receiving benzodiazepines orZ-drugs on a long-term basis, the prescription of a benzodiazepine or Z-drug for>21 days | 8 | Agreement |
B5(a)a | In an older person (>65 years) with depression, the prescription of a long-term benzodiazepine (that is, >21 days) | 5 | Disagreement |
B5(a)Xc | In an older person (>65 years) with depression, the prescription of a long-term benzodiazepine or Z-drug (that is, >21 days) | 6 | Disagreement |
B5(b)a | In an older person (>65 years) with depression initiation of benzodiazepine on a long-term basis (that is, >21 days) | 8 | Equivocal |
B5(b)Xa,b,c | In an older person (>65 years) with depression initiation of benzodiazepine orZ-drugs on a long-term basis (that is, >21 days) | 8 | Agreement |
B6 | In a patient with COPD, the prescription of a benzodiazepine | 4 | Agreement |
B6Xc | In a patient with COPD, the prescription of a benzodiazepine or Z-drug | 4 | Agreement |
B7(a)a | In an older patient (>65 years) with a history of falls, the prescription of either a benzodiazepine, an antipsychotic, or a tricyclic antidepressant | 3 | Agreement |
B7(a)Xa,c | In an older patient (>65 years) with a history of falls, the prescription of a benzodiazepine, a Z-drug, an antipsychotic, or a tricyclic antidepressant | 3 | Agreement |
B7(b)a | In an older patient (>65 years) with a history of falls, the prescription of a benzodiazepine | 4 | Equivocal |
B7(b)Xa,c | In an older patient (>65 years) with a history of falls, the prescription of a benzodiazepine or Z-drug | 4 | Equivocal |
B7(c)a | In an older patient (>65 years) with a history of falls, the prescription of an antipsychotic | 3.5 | Equivocal |
B7(d)a | In an older patient (>65 years) with a history of falls, the prescription of a tricyclic antidepressant | 3.5 | Equivocal |
B8 | In an older patient (>65 years) with hyponatraemia/syndrome of inappropriate antidiuretic hormone secretion, the prescription of a selective serotonin reuptake inhibitor | 4 | Equivocal |
B9 | In an older person (>65 years) with cognitive impairment, the prescription of an anti-muscarinic drug | 3.5 | Equivocal |
B10 | In a patient with angle closure glaucoma, the prescription of an anti-muscarinic drug | 4 | Equivocal |
C: Anti-infective agents | |||
C1 | Prescription of a tetracycline to a child aged >12 years | 5 | Equivocal |
C2(a)a | Prescription of mefloquine to a patient with a history of psychiatric disorder (including depression) | 6 | Disagreement |
C2(b)a,b | Prescription of mefloquine to a patient with a history of convulsions | 8 | Agreement |
C2(b)Xa,c | Prescription of mefloquine to a patient with a history of epilepsy | 3 | Equivocal |
C3 | In an older patient (>65 years) long-term prescription of nitrofurantoin (that is, ≥28-day prescription) | 6 | Disagreement |
D: Women's health and urinary disorders | |||
D1b | Prescription of a combined hormonal contraceptive to a woman with a history of venous or arterial thromboembolism | 9 | Agreement |
D2(a)a,b | Prescription of oral ortransdermal oestrogens to a woman with a history of breast cancer | 9 | Agreement |
D2(b)a | Prescription of a topical (vaginal) oestrogen to a woman with a history of breast cancer | 5 | Equivocal |
D3b | Prescription of oral ortransdermal oestrogen without progesterone in a woman with an intact uterus | 9 | Agreement |
D4 | Prescription of an anti-muscarinic drug to a patient with bladder outflow obstruction | 3 | Agreement |
D5Xa,b,c | Prescription of a combined hormonal contraceptive to a woman aged a35 years who is a current smoker | 8.5 | Agreement |
D6Xb,c | Prescription of a combined hormonal contraceptive to a woman with body mass index of ≥40 | 8 | Agreement |
E: Musculoskeletal | |||
E1(a)a,b | Prescription of a non-selective NSAID to a patient with a history of peptic ulceration | 8 | Agreement |
E1(a)Xa,b,c | Prescription of an NSAID to a patient with a history of peptic ulceration | 9 | Agreement |
E1(b)a,b | Prescription of a non-selective NSAID to an older patient (>65 years) with a history of peptic ulceration | 8 | Agreement |
E1(b)Xa,b,c | Prescription of an NSAID to an older patient (>65 years) with a history of peptic ulceration | 9 | Agreement |
E1(c)a,b | Prescription of a non-selective NSAID, without co-prescription of an ulcer healing drug, to a patient with a history of peptic ulceration | 8 | Agreement |
E1(c)Xa,b,c | Prescription of an NSAID, without co-prescription of an ulcer healing drug, to a patient with a history of peptic ulceration | 9 | Agreement |
E2 | Prescription of a selective COX-2 inhibitor NSAID to a patient with cardiovascular disease (for example, CHD, cerebrovascular disease, or peripheral arterial disease) | 3 | Equivocal |
E3 | In an older patient (>65 years), prescription of an NSAID without co-prescription of an ulcer healing drug (for example, misoprostol or a proton pump inhibitor) | 6 | Equivocal |
E4 | In an older patient (>65 years), prescription of a long-term (a28 days) full-dosage, longer half-life non-COX-2-selective NSAID | 4 | Equivocal |
E5b | In an older patient (>65 years) with heart failure, the prescription of an NSAID | 8 | Agreement |
E5Xb,c | In a patient with heart failure, the prescription of an NSAID | 8 | Agreement |
E6b | In an older patient (>65 years) with chronic renal failure, the prescription of an NSAID (for example, CKD 3 or worse) | 8 | Agreement |
E6Xb,c | In a patient with chronic renal failure, the prescription of an NSAID (for example, CKD 3 or worse) | 8.5 | Agreement |
E7b | In an older patient (>65 years) prescription of a long-term (>28 days) NSAID (except for ibuprofen ≤1200 mg daily) | 7 | Agreement |
F: Hazardous co-prescriptions, interactions, and allergy | |||
F1 | Prescription of warfarin and aspirin in combination, without co-prescription of an ulcer healing drug | 6 | Disagreement |
F2b | Prescription of warfarin in combination with an oral NSAID | 7.5 | Agreement |
F3b | Prescription of a phosphodiesterase type-5 inhibitor (for example, sildenaf il) to a patient who is also receiving a nitrate or nicorandil | 8 | Agreement |
F4(a)a | Prescription of clarithromycin or erythromycin to a patient who is also receiving simvastatin | 4.5 | Disagreement |
F4(b)a,b | Prescription of clarithromycin or erythromycin to a patient who is also receiving simvastatin, with no evidence that the patient has been advised to stop the simvastatin while taking the antibiotic | 7 | Agreement |
F5(b)a,b | Prescription of a potassium salt or potassium-sparing diuretic (excluding aldosterone antagonists, such as spironolactone) to a patient who is also receiving an ACE inhibitor or angiotensin II receptor antagonist | 8 | Agreement |
F6b | Prescription of verapamil to a patient who is also receiving a beta-blocker drug | 8 | Agreement |
F7 | Prescription of quinine to a patient who is also receiving a cardiac glycoside, for example, digoxin | 5 | Equivocal |
F8 | Prescription of ciprofloxacin or norfloxacin to a patient who is also receiving theophylline | 5 | Agreement |
F9b | Prescription of a penicillin-containing preparation to a patient with a history of allergy to penicillin | 8.5 | Agreement |
F10 | Prescription of warfarin and aspirin in combination | 6 | Equivocal |
G: Laboratory test monitoring | |||
G1b | Prescription of warfarin to a patient without a record of INR having been measured within the previous 12 weeks | 7 | Agreement |
G1Xb,c | Prescription of warfarin to a patient without a record of INR having been measured within the previous 12 weeks (excluding patients who self monitor) | 8 | Agreement |
G2 | Prescription of amiodarone without a record of liver function being measured in the previous 6 months | 7 | Equivocal |
G2Xb,c | Prescription of amiodarone without a record of liver function being measured in the previous 9 months | 8 | Agreement |
G3 | Prescription of amiodarone without a record of thyroid function being measured within the previous 6 months | 7 | Equivocal |
G3Xb,c | Prescription of amiodarone without a record of thyroid function being measured within the previous 9 months | 8 | Agreement |
G4b | Prescription of an ACE inhibitor without a record of renal function and electrolytes being measured prior to starting therapy | 7.5 | Agreement |
G4Xb,c | Prescription of an ACE inhibitor or angiotensin II receptor antagonist without a record of renal function and electrolytes being measured prior to starting therapy | 8 | Agreement |
G5(a)a | Prescription of lithium without a record of a lithium level being measured within the previous 3 months | 6.5 | Equivocal |
G5(b)a,b | Prescription of lithium without a record of a lithium level being measured within the previous 6 months | 8 | Agreement |
G6b | Prescription of methotrexate without a record of a full blood count within the previous 3 months | 8 | Agreement |
G6Xc | Prescription of methotrexate without a record of a full blood count within the previous 4 months | 7 | Equivocal |
G7b | Prescription of methotrexate without a record of liver function having been measured within the previous 3 months | 8 | Agreement |
G7Xc | Prescription of methotrexate without a record of liver function having been measured within the previous 4 months | 6.5 | Equivocal |
↵a Indicators ending in letters ‘(a)’, ‘(b)’, (c), or ‘(d)’ are variations in the wording of indicators used in the first round (and repeated in the second round) of the exercise
↵b Indicators highlighted in bold are those rated appropriate for assessing the safety of prescribing of individual GPs for the purposes of revalidation.
↵c Indicators ending in ‘X’ are variations on indicators (or new indicators) suggested by the panel and assessed in the second round only. ACE = angiotensin-converting enzyme. ARB = angiotensin receptor blocker. CHD = coronary heart disease. CKD = chronic kidney disease. COPD = chronic obstructive pulmonary disease. INR = international normalised ratio. NSAID = nonsteroidal anti-inflammatory drug.