Clinical Effectiveness Prescribing Programme (CEPP)
All Wales Audit/Review Pack:
Reducing the use of High Acquisition Cost
(HAC) Proton Pump Inhibitors (PPI)
2011-2013
Quality and Cost Improvement Toolkit
This audit was endorsed by the All Wales Medicines Strategy Group (AWMSG) at their
meeting on the 16th March 2011 and forms part of the Clinical Effectiveness
Prescribing Programme, formerly known as the Prescribing Incentive Scheme.
Please send the Data Summary Sheets 1-2 and the Practice Review Sheet to your local
Medicines Management team on or before the 31st October 2011.
Your Medicines Management team will compile the local information and forward to
the Welsh Medicines Partnership (wmp@wales.nhs.uk) who will provide a national
perspective (which is required by the Welsh Assembly Government).
Contents
Page
Background
3
Purpose and Summary of Document
3
Introduction
4
Useful Resources
7
Aim of the Audit
7
Audit Criteria
7
Review Criteria
8
Method
8
Results and Reflection
10
References
11
Sample Individual PPI Patient Collection Sheet
12
Collated Patient Data Sheet
13
Data Summary Sheet (1)
14
Data Summary Sheet (2)
15
Practice Review Sheet
16
Appendix A – Sample Selection
17
2
Clinical Effectiveness Prescribing Programme (CEPP)
All Wales Audit/Review Pack:
Reducing the use of High Acquisition Cost
(HAC) Proton Pump Inhibitors (PPI)
2011-2013
Quality and Cost Improvement Toolkit
Background:
Quality improvement toolkits have been developed to assist general practices in collating and
auditing information. These are produced with reference to evidence-based practice and Welsh
priorities. They should be seen as good practice and are intended to improve data quality and aid
development within the practice.
Improvements in practice will be optimised by multidisciplinary involvement in the audit and team
discussion of the results. It is recommended that action plans implemented following this audit
are reviewed within six months and re-audit undertaken if possible in 6-12 months.
Purpose and Summary of Document:
The following audit/review has been developed by the Welsh Medicines Partnership. This
document is for use by primary care general practitioners to highlight prescribing and
cost-effectiveness issues with PPIs. It will be available via the AWMSG website.
The audit will be available from April 2011, so that it can be used as one of the CEPP national
audits for the following two years (2011–2013).
Also included is a practice review section designed to encourage a whole practice response to the
audit findings and an evaluation of the quality and usefulness of the audit itself.
3
1. Introduction
1.1 Indications for use
Dyspepsia is defined as any symptom of the upper gastrointestinal tract, present for four weeks or
more, including upper abdominal pain or discomfort, heartburn, acid reflux, nausea or vomiting1.
Of the adult population, 40% will have symptoms of dyspepsia, leading to 5% consulting their GP,
and 1% being referred for endoscopy. In patients with symptoms severe enough to be referred
for endoscopy, 40% will have functional dyspepsia, 40% will have gastro-oesophageal reflux
disease (GORD) and 13% some sort of ulcer1.
PPIs are licensed and prescribed for a range of indications including1,2:
 Uninvestigated and non-ulcer (or functional) dyspepsia
 GORD
 Peptic ulcers
 Eradication of Helicobacter pylori (in combination with antibiotics)
 Control of excessive acid secretion in patients with Zollinger-Ellison syndrome
 Prevention and treatment of nonsteroidal anti-inflammatory drug (NSAID) associated
ulcers.
In addition, other indications for PPIs, encompassing unlicensed uses, that are common in hospital
settings include the reduction of re-bleeding episodes after treatment of severe peptic ulcer
bleeding, prophylaxis of acid aspiration during general anaesthesia and stress ulcer prophylaxis2.
1.2 Prescribing across Wales
PPI use is continuing to increase across Wales. One possible explanation for this is that they are
continued when they are no longer indicated2, as for many indications, such as peptic ulcer
disease, treatment courses are intended for short term use only1. It has also been suggested that
a reduction in cost, together with reduced concerns of their safety has led to a more liberal use of
PPIs for a wide variety of upper gastrointestinal symptoms with a substantial proportion, if not
majority, of patients now prescribed PPIs have no true indication for treatment3.
Items Per 1000 PU's
National GP (Proton Pump Inhibitors)
250.00
National GP
200.00
ABMU - GP
Aneurin Bevan - GP
150.00
Betsi Cadwaladr Uni - GP
100.00
Cardiff And Vale Uni - GP
50.00
Cwm Taf - GP
0.00
20
07
1
20 2
08
0
20 3
08
0
20 6
08
20 09
08
1
20 2
09
0
20 3
09
20 06
09
0
20 9
09
1
20 2
10
0
20 3
10
06
Hywel Dda - GP
Powys Teaching - GP
The June 2010 average All Wales figure for the PPI National Prescribing Indicator was 5208.51
DDD* per 1,000 patient units (PUs) ranging from 4,123.50 to 6,915.33 across the 22 former Local
Health Board (LHB) localities4.
*The Defined Daily Dose (DDD) is a measure of prescribing volume maintained by the World
Health Organisation (WHO) and represents the assumed average maintenance dose per day for a
drug used for its main indication in adults. It allows prescribing activity to be compared fairly and
accurately across localities.
4
1.3 Prescribing costs
There has been a decrease in the overall costs of PPIs over the past few years due to the
availability and reduction in costs of generic omeprazole 10mg and 20mg capsules, lansoprazole
15mg and 30mg capsules, and more recently pantoprazole 20mg and 40mg tablets. Other
formulations of omeprazole and lansoprazole (e.g. generic tablets and dispersible tablets), liquid
specials and branded preparations are considerably more expensive, as are other PPIs such as
esomeprazole (Nexium®) and rabeprazole (Pariet®). Although only 14% of the items prescribed
in Wales are for the more costly preparations they account for 37% of the cost (quarter ending
Sept 10)4.
In the former 22 LHB localities, low acquisition cost (LAC) PPIs account for between 81% and 90%
of the items prescribed (quarter ending Sept 10). For a similar indicator in England, the upper
quartile of Trusts are currently achieving 92%5. Increasing the All Wales percentage of LAC PPIs
to 92%, assuming the number of prescription items remain the same, would potentially save over
£1.5 million per annum (extrapolated data for the quarter ending Sept 10)4.
There is no evidence that, at equivalent doses, any one PPI is more effective at healing
oesophagitis than another1. Newer PPIs offer no advantages in terms of clinical efficacy, and
there is less evidence for long term safety6. They are also considerably more expensive, and NICE
guidelines recommend that the least expensive PPI should be used1. Therefore, generic
lansoprazole and omeprazole* capsules or pantoprazole tablets should be used as first line
therapies.
PPI
Omeprazole
Lansoprazole
Pantoprazole
Usual Doses for PPIs 6
High Dose
Full Dose
*
40mg
20mg
30mg
40mg
Low Dose
10mg
15mg
20mg
Rabeprazole
Esomeprazole
40mg
10mg
-
20mg
20mg
* using 2x20mg capsules of omeprazole is more cost effective than 40mg capsules7
1.4 Emerging concerns with PPI use
Although PPIs are generally well tolerated, there is emerging evidence with regards to the
potential consequences of potent acid suppression8. The incidence of short-term adverse events is
low. There is, however, evidence to suggest that some serious adverse effects may be linked with
long term PPI use, and although some of the evidence is conflicting, safety concerns have been
raised2. Adverse effects investigated include increased risk of osteoporotic fractures of the hip,
wrist and spine, Clostridium difficile infection (CDI), both hospital-associated and communityacquired pneumonia, and a possible association with colorectal cancer2,8.
1.5 Stepping down and/or stopping PPIs
There is a potential risk of psychological dependence on PPIs and it has been recommended by
NICE that patients on these medications long term are reviewed on an annual basis1. During this
review NICE guidance suggests that where appropriate patients should be:
 Encouraged to try stepping down or stopping treatment
 Offered lifestyle advice
 Advised on how to avoid precipitants that contribute to their dyspepsia.
Patients often find it difficult to step-down or step-off PPI therapy, and evidence now suggests
that PPI withdrawal may lead to rebound acid hypersecretion. A study by Reimer et al found that
eight weeks of PPI therapy induced acid-related symptoms in healthy volunteers after withdrawal
of therapy9. This may have implications in clinical practice. If a similar increase in such symptoms
5
is seen in patients on withdrawal of PPI, this will lead to reliance on these medications and an
increased requirement for long term treatment2,3. NICE recommends that when patients are
stepping down or stepping off therapy, a return to self care may be appropriate, with
antacid/alginate therapy taken as required1.
1.6 General prescribing points
Prescribers are reminded that:

PPIs should only be started or continued where there is a valid documented indication.
The use of PPIs for mild or vague symptoms and any ‘diagnostic’ use must be short term2.

All patients on a long term PPI should have an annual review to discuss continuing need for
medication and/or stepping down treatment, unless there is an underlying condition or
co-medication that necessitates ongoing treatment10.

NICE recommendations state that the least expensive PPI should be used1. There is no
evidence that there is any difference in clinical efficacy between PPIs at equivalent doses6,
although prescribers should be aware that there are some slight variations in the
indications for use, interactions and cautions11. Generic omeprazole and lansoprazole
capsules or pantoprazole tablets should be used as first-line therapies.

Some medications can contribute to the symptoms of dyspepsia (examples include calcium
antagonists, nitrates, theophyllines, bisphosphonates and NSAIDs)10. Existing medication
should be reviewed, and if a causative medication is identified withdrawal should be
considered6.

Initial therapeutic strategies for dyspepsia are empirical treatment with a PPI or testing for
and treating H. pylori. There is currently insufficient evidence to guide which should be
offered first10. A two week washout period following PPI use is necessary before testing for
H. pylori with a breath test or stool antigen test10. Patients diagnosed with peptic ulcer
should also be tested and treated for H. pylori; however, there is currently no evidence that
H. pylori should be investigated in patients with GORD10.

NICE recommends that a PPI (with the lowest acquisition cost) should be co-prescribed in
patients treated with an oral NSAID/COX-2 inhibitor12. Before using an NSAID which
requires concurrent use of a PPI, it should be established whether all other strategies to
optimise pain control have been considered8.

PPI withdrawal may induce rebound acid hypersecretion2,8. This may explain the continued
use of PPIs in patients and the inability to discontinue treatment. Patients should therefore
be informed of this potential risk when both stepping down and stopping therapy.
Consideration should also be given to implementing strategies that may reduce rebound
acid hypersecretion such as intermittent dosing (where clinically appropriate), or the use of
antacid/alginate therapy8.

In general PPIs are well tolerated. There have however been a number of recent reports
which have documented concerns about possible adverse events relating to their use.
These include a small increase in the risk of both hospital-acquired and
community-acquired pneumonia13,14 and possible increase in fracture risk15. This should be
taken into consideration when prescribing a PPI in those patients with other risk factors for
these conditions8.

The Health Protection Agency and Department of Health Guidance on managing CDI
recommends that PPIs should only be used when there is a clear clinical indication16. The
6
guidance also states that consideration should be given to stopping PPIs in recurrent cases
of CDI.

Current evidence regarding interactions between clopidogrel and PPIs is not consistent;
however, the MHRA has advised that the combination of clopidogrel and omeprazole or
esomeprazole should be avoided unless considered essential17.
1.7 Good practice points to consider for this audit and during review of any PPI:
 Is there a legitimate indication for a PPI?
 Can the PPI be stopped? – e.g treatment course finished/NSAID discontinued therefore
prophylaxis no longer necessary.
 Has the patient been tested and treated for H. pylori where appropriate?
 Could any medications that can cause dyspepsia be withdrawn?
 Have other strategies to optimise pain control been considered before using an NSAID that
requires concurrent use of a PPI 8?
 Where a PPI needs to be continued can the dose be reduced?
 When stepping down or stopping therapy, has consideration been given to prescribing
antacid/alginate for rebound acid hypersecretion?
 Have lifestyle measures been discussed and the patient advised on how to avoid
precipitating factors?
 Has consideration been given to the risks associated with PPIs, particularly in patients with
multiple risk factors for hospital-associated and community-acquired pneumonia, fractures
or C.difficle infection8?
 The combination of clopidogrel and omeprazole or esomeprazole should be avoided unless
considered essential.
 Where it is necessary to continue on treatment with a PPI, is the patient on the most
cost-effective, appropriate PPI?
 practices could consider using specific read-codes for discussions with patients regarding
stepping down or stopping PPIs and providing lifestyle advice
2. Useful Resources




NICE Guidance - Dyspepsia: management of dyspepsia in adults in primary care10
WeMeReC Bulletin. Stopping medicines – proton pump inhibitor2
National Prescribing Centre. MeReC Briefing - The management of dyspepsia in primary
care6
Map of medicine - www.mapofmedicine.com
3. Aim of the Audit/Review




To estimate the percentage of patients who have an active repeat prescription for a HAC
PPI on their record.
To review all patients on a HAC PPI in line with NICE guidance.
To ensure all repeat HAC PPI prescribing is appropriate.
To reduce the use of HAC PPIs and increase the use of LAC PPIs relative to HAC PPIs
4. Audit Criteria




All patients should have an indication for therapy when the PPI was initially prescribed.
All patients on a repeat prescription for a PPI should have a documented indication for long
term use.
All patients prescribed a HAC PPI should have a documented reason for not being
prescribed a cost-effective alternative.
All patients should have a record of lifestyle advice recorded.
7
5. Review Criteria



Patients with no indication for long term PPI should be stopped where appropriate.
Patients requiring long term treatment with a PPI should be switched to a LAC PPI where
appropriate.
Patients on high and full doses of a PPI should have the dose reduced where appropriate.
6. Method
1. Find the total number of patients with an active repeat prescription for a PPI (A):
Search the practice computer system for all patients with an active repeat prescription for a PPI
(remember to search for branded products as well). Enter the figures for the total number of
patients on the data summary sheet.
Some computer systems will allow a search on the action group for PPIs to avoid having to enter
the drugs individually. However, if you are not able to perform this search, the generic and
branded names for PPIs are given below.
PPI
Generic
Branded
Esomeprazole
Nexium®
Pantoprazole
Rabeprazole
Protium®
Pariet®
Omeprazole
Losec®
Lansoprazole
Zoton®
(Tip- remember to include all formulations of PPIs including dispersible tablets and liquid specials)
2. Exclude patients prescribed a LAC PPI (B)
Search the practice computer system for any patients currently receiving a repeat prescription for
a LAC PPI (these are generic lansoprazole 15 and 30mg capsules, omeprazole 10 and 20mg
capsules and pantoprazole 20mg and 40mg tablets). Enter the figures for the total number of
patients on the data summary sheet. These patients should be excluded from this audit as they
are the most cost-effective preparations.
LAC PPI
Omeprazole 10mg capsules
Lansoprazole 15mg capsules
Omeprazole 20mg capsules
Lansoprazole 30mg capsules
Pantoprazole 20mg tablets
Pantoprazole 40mg tablets
3. Patients suitable to be included in the audit (C)
Establish the total number of patients suitable for inclusion in the audit. This will involve removing
patients on an LAC PPI (B) from the original list (A).
4. Sample (D):
Select a number of patients on a HAC PPI to audit. Appendix A indicates a sample size which
would give statistically significant results. The proportion of patients to sample may alternatively
be decided at local level. Randomly select these patients from this list of patients to the required
number. For practices where this number is less than 50, it would be expected that all patients be
reviewed.
8
5. Complete patient data collection and carry out the patient reviews:
A sample individual patient data collection/review form has been included and can be adapted
for local use. Use the patients’ medical records to complete these forms and transfer the data to
the collated patient data collection sheet.
Review patients for their continuing need for a PPI, reduction in dose and suitability for switching
to a cost-effective alternative. Any recommendations should then be actioned.
6. Find the post-audit/review percentage of LAC PPI
After the audit/review is completed, and any necessary changes actioned, re-run searches (A) and
(B) to find the new percentage.
Notes:
Indications for initiating a PPI
Treatment of peptic ulcer disease (gastric and duodenal)
Uninvestigated dyspepsia / reflux-like symptoms
Investigated non-ulcer dyspepsia (NUD)
GORD (endoscopy negative reflux disease and oesophagitis)
Other
As part of a H. pylori eradication regimen
Prophylaxis of NSAID-induced dyspepsia/ulceration
Zollinger-Ellison syndrome
Barretts oesophagus
Oesophageal stricture or ulcer
Indications for long term use (PPI should be continued at current dose)
Severe oesophagitis (Grades C and D)
Prophylaxis of NSAID-induced dyspepsia/ulceration
Zollinger-Ellison syndrome
Barretts oesophagus
Oesophageal stricture or ulcer
Lifestyle advice10 – this should include:
- healthy eating and avoidance of food/drink which exacerbate symptoms
- avoiding reclining or lying down shortly after meals, and large, late meals
- weight reduction (if overweight or obese)
- smoking cessation
- moderation of alcohol consumption
Annual medication review
- Medication Review Read Code and documentation regarding continuation of long
term PPI in the patient record
7. Complete the Data Summary sheets 1 and 2.
8. Complete Practice Review sheet (see points below and data from the summary
sheets to inform discussion.)
9. Return the Data Summary sheets 1–2 and the Practice Review sheet to your
Medicines Management team on or before the 31st October 2011.
9
7. Results and Reflection
When



completing the Practice Review sheet consider:
Are the results what we expected?
Can we make any improvements?
What might be stopping us getting better?
Discuss the results of the audit within the practice. Details from the audit forms and summary
may help identify further groups of patients to prioritise for review, or indicate patterns of
prescribing on which to comment.
Identify areas for improvement and formulate an action plan to optimise prescribing:
 Decide what it is that you want to achieve
 Think about how you will know if you are improving or not
 Generate ideas for the things that you could do differently
 Use some of the reference material to inform debate and discussion
 Record your progress.
See section 1.7 (page 7) for notes and good practice points for reviewing PPIs.
10
8. References
1. North of England Dyspepsia Guideline Development Group. Dyspepsia: managing dyspepsia in
adults in primary care.
Full Clinical Guideline No. 17. 2004.
Available at
http://guidance.nice.org.uk/CG17. Accessed Sept 2010.
2. WeMeReC Bulletin. Stopping medicines – proton pump inhibitors. Online content. October2010.
Available at: http://www.wemerec.org/Documents/enotes/StoppingPPIsenotes.pdf. Accessed
Nov 2010.
3. McColl KEL, Gillen D. Evidence that proton-pump inhibitor therapy induces the symptoms it is
used to treat. Gastroenterology 2009; 137: 20-39.
4. Prescribing Services Unit, Health Solutions Wales. Comparative Analysis System for Prescribing
Audit (CASPA) 2010.
5. NHS Institute for Innovation and Improvement. NHS Better Care, Better Value Indicators.
Available at
http://www.productivity.nhs.uk/Indicator/626/For/National/And/25th/Percentile Accessed Jan
2011.
6. National Prescribing Centre. The management of dyspepsia in primary care. MeReC Briefing.
2006. Issue number 32. Available at
http://www.npc.co.uk/ebt/merec/therap/dysp/resources/merec_briefing_no32.pdf.
Accessed
Sept 2010
7. Drug Tariff, January 2011.
8. Thompson A. Emerging Concerns with PPI therapy. The Pharmaceutical Journal 2010;
285:239-240. www.pjonline.com
9. Reimer C, Søndergaard B, Hilsted L et al. Proton–pump inhibitor therapy induces acid-related
symptoms in healthy volunteers after withdrawal of therapy.
Gastroenterology 2009;
137:80-87.
10. National Institute of Health and Clinical Excellence. Dyspepsia: management of dyspepsia in
adults in primary care. Clinical Guideline 17. 2004.
11. British National Formulary. BNF 60. September 2010.
12. National Institute of Health and Clinical Excellence. Osteoarthritis. The care and management
of osteoarthritis in adults.
Clinical Guideline 59.
2008.
Available at
http://www.nice.org.uk/CG59. Accessed Sept 2010.
13. Herzig SJ, Howell MD, Ngo LH et al. Acid-suppressive medication use and the risk for hospitalacquired pneumonia. JAMA 2009; 301:2120-2128.
14. Sarkar M Hennessy S, Yang YX. Proton-pump inhibitor use and risk for community-acquired
pneumonia. Ann Intern Med 2008; 149:391-398.
15. U.S Food and Drug Administration (FDA). FDA Drug Safety Communication. Possible
increased risk of fractures of the hip, wrist and spine with the use of proton pump inhibitors.
May 2010. Available at
http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders
/ucm213206.htm. Accessed Sept 2010.
16. Health Protection/Department of Health. Clostridium difficile infection: how to deal with the
problem. 2009. Available at
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1232006607827. Accessed Sept 2010.
17. Drug Safety Update April 2010, vol 3 issue 9: 4. Available at
http://www.mhra.gov.uk/home/groups/pl-p/documents/publication/con076503.pdf. Accessed
Sept 2010.
11
Sample Individual PPI Patient Collection Form
Patient Name _________________________ D.O.B _______________
Patient ID______________
PPI Prescribed
Omeprazole 
Lansoprazole 
Pantoprazole 
Rabeprazole 
Esomeprazole 
Dose/Frequency_____________ Formulation _________________ Length of treatment___________
Documented valid reason for HAC PPI - No 
Yes  please specify ___________________________
Current PPI initiated in: primary care -  secondary care - 
Indication on initiation
Uninvestigated dyspepsia

Uninvestigated reflux–like symptoms 
Endoscopy confirmed DU

Endoscopy confirmed GU
NSAID prophylaxis
Not documented



Investigated NUD

Endoscopy confirmed GORD 
Other  - Please specify ______________
Indication for long term use No  Yes  please specify ________________________________
PPI review within last 12 months yes -  no - 
Lifestyle advice recorded yes -  no - 
Reviewer recommendations/comments
(include any relevant medical information to support recommendation and any local exclusion criteria)
Recommendation:
Continue unchanged

Stopped

Continue at reduced dose 
Switch to LAC PPI at equivalent dose

State which________________________
Switch to LAC PPI at reduced dose

State which________________________
Other  _______________________________________________
Name ________________________ Signature __________________ Date __________________
Doctors recommendation/comments
Agree with above recommendation 
Other  __________________________________________
Doctor signature __________________ Date __________________
Action taken by:
Pharmacist/Technician 
Practice 
Signature _______________________ Date ____________
12
Collated Patient Data Sheet
Patient ID/Number
Daily dose
Full
Low
High
Intermittent/Symptom driven
Yes/No
Reason for HAC
PPI documented?
Uninvestigated dyspepsia
Diagnosis/
indication
recorded
when
PPI Initiated
Uninvestigated reflux-like
symptoms
Investigated NUD
Endoscopy confirmed peptic
ulcer
GORD (endoscopy confirmed)
NSAID prophylaxis
Other
Not specified
Yes/No
Indication for
long term use?
Primary Care
Initiation of HAC
PPI
Secondary Care
Yes/No
PPI review in last
12 months?
Lifestyle advice
recorded?
Yes/No
HAC PPI to continue unchanged
PPI stopped
Outcome
Continue on HAC PPI at
reduced dose
PPI switched to LAC PPI at
equivalent dose
PPI switched to LAC PPI at
reduced dose
Other
13
Data Summary Sheet (1)
Practice __________________________ Date of Audit _______________
Percentage of
practice population
Number
Practice list size
100%
(A) Number of patients in the practice with
an active repeat prescription for a PPI
(B) Number of patients prescribed a LAC*
PPI
(C) Number of patients suitable for this
audit = (A) – (B )
*LAC PPIs are lansoprazole 15mg and 30mg capsules, omeprazole 10mg and 20mg capsules and
pantoprazole 20mg and 40mg tablets only.
Practice
percentage
pre-audit/review
Percentage of LAC PPI to HAC PPI (B/A x 100)
Number
(D) Sample size
i.e. number of patients from (C) included in the
audit
Number of patients with a documented
indication for therapy when PPI initially
prescribed
Number of patients with a documented
indication for long term use
Number of patients who have had lifestyle
advice documented in their notes with in the
last 12 months
Patient has had a review of their PPI in the last
12 months?
%
Suggested
audit standard*
92%
Percentage of
the audit sample
Suggested
audit standard*
100%
NA
90%
90%
90%
90%
*these represent realistic standards based on clinicians’ discussions as objectives for the time of
the audit cycle.
14
Data Summary Sheet (2)
Factor
Number of patients with
this characteristic
Total sampled
Standard daily dose
Low daily dose
High daily dose
Intermittent/symptom-driven regimen
HAC PPI initiated in Primary Care
HAC PPI initiated in Secondary Care
Outcomes
Number of patients with
this characteristic
Factor
HAC PPI to continue unchanged
PPI stopped
Continue on HAC PPI at reduced dose
PPI switched to LAC PPI at equivalent
dose
PPI switched to LAC PPI at reduced dose
Other
(E) Total number of patients on PPI post
audit
(F) Total number of patients on LAC post
audit
Practice
percentage
post audit/review
Percentage of LAC PPI to HAC PPI (F/E x 100)
%
Suggested
audit standard*
92%
Please send the Data Summary sheets 1-2 and the Practice Review Sheet to your local Medicines
Management Team who will compile the local information and forward to the Welsh Medicines
Partnership for a national perspective.
15
Practice Review Sheet
A. What lessons did the practice discover from carrying out this audit/review?
B. What discussion/activities did the practice undertake as a result of the audit/review?
C. What changes have the practice agreed to implement as a result of this audit/review?
This audit was completed by:
Name(s)
__________________________________________________________________
Signature(s)
___________________________________________________________________
Practice (name and address)
______________________________________________________________________________
________________________________________________________________________________
Please send the Data Summary sheets 1-2 and the Practice Review Sheet to your local Medicines
Management Team who will compile the local information and forward to the Welsh Medicines
Partnership for a national perspective.
16
Appendix A
Sample selection
Total number of patients on HAC PPI
Sample size:
95% confidence; +/-5%
44
79
108
132
50
100
150
200
17