On this page
The benefits of this project
Benefits for Your Patients
- Less medication to take
- Fewer side effects
- Lower bleeding risk
Benefits for Your Practice
- Fewer side effects so may decrease need for GP appointments
- Financial savings from reduced medicines spend
Benefits for The Planet
- Reduced prescribing means lower environmental impact
Opportunity for improvement
- This project aims to help practices prescribe dual antiplatelet therapy appropriately for patients(see disclaimers). This is key for several reasons:
- Reduce side effects and bleeding risk
- NICE guidelines advise that dual antiplatelet therapy (DAPT) is usually continued for 12 months following acute coronary syndrome or 6 months following PCI for stable coronary artery disease. If DAPT is continued beyond the recommended course, the bleeding risk may outweigh the benefits.
- Reduce inappropriate polypharmacy
- There is evidence to suggest that between one third and a half of medication prescribed for long term conditions are not taken as recommended. There is also significant morbidity associated with inappropriate polypharmacy and adverse effects of medication causes an estimated 11% of unplanned hospital admission.
- Reduce carbon footprint from inappropriate polypharmacy
- Medicines and chemicals account for 20% of the NHS total carbon footprint and this proportion is significantly higher within primary care.
- You might like to make a SMART goal for this project, e.g. within the next 6 months, ensure 100% of patients prescribed DAPT have a documented review date aligned with NICE guidelines in their records, with a system alert for timely deprescribing.
How to carry out this project
-
Identify patients
Run a search for patients prescribed dual antiplatelet therapy (two of either aspirin, clopidogrel, ticagrelor or prasugrel) within the last 6 months. Identify patients whose prescription has continued beyond the intended course length (as per NICE guidance/the timeframe recommended by secondary care).
We hope to provide downloadable IT searches for EMIS & System 1 soon. In the meantime, you could use our EMIS and SystmOne search guides to create your own.
-
Discussion & Training
Run a training session for clinicians on dual antiplatelet appropriate prescribing. Discuss the search findings and how to improve DAPT prescribing.
The practice may like to develop a Standard Operating Procedure (SOP) for DAPT prescriptions. This could include a system to ensure there is an end date included in the directions of the antiplatelet prescription due to be stopped, visible to both patient and clinician, and consideration of PPI discontinuation at the same time.
-
Communicate with local pharmacies
You might like to involve your local community pharmacists so they are aware of the recommendations and can support with consistent messaging to patients. Your practice pharmacist will likely know how best to get in touch with them.
-
Review
Contact the patients identified to discuss discontinuation.
If the lack of clarity exists about the course length, contact secondary care team (usually cardiology) via Advice and Guidance Service.
-
Record
Record the number and type of medications stopped.
-
Study
Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process. Decide when to re-audit again to ensure the change has lasted e.g. 2-3 months and use the Project Monitoring form to keep track.
Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.
Top tip
“Involving stake holders early can help to maintain the changes. Although I worked with the pharmacy team early in the project, I did not feedback to the wider team until the end. I think it would help to involve all prescribers in the practice sooner.”
GP trainee
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
Your wider organisation e.g. PCN, Cluster, ICB or Healthboard might like to implement this project across their practices to spread its reach.
You could work with local pharmacy and hospital teams to ensure consistent messaging about DAPT in medicines formularies and that the length of treatment is always included in the discharge summary.
Case study
“This was a relatively straightforward project which I was able to complete during a 6-month rotation as a GP trainee in ST2. Although the overall numbers of medications stopped are fairly small, the individual impact for patients is significant due to the reduced bleeding risk. There is an overall cost and carbon saving.
Making phone calls to patients individually took some time, however an alternative approach would be to use text messages alone.
On an individual level, this project enabled me to gain an insight into deprescribing through a small and focussed project.”
GP trainee
East Trees Health Centre, Bristol
Have you completed this QIP?
Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost and carbon savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
More project guides
-
Extreme Cold Weather Alert QIP
Carbon saving potential: Solid
<10 hours
-
Bath & Shower Emollient Deprescribing
Carbon saving potential: High
<10 hours
-
Reducing Emissions Associated with Banking
Carbon saving potential: Very high
20-40 hours
-
Switching Energy Provider
Carbon saving potential: Very high
<10 hours