This area forms part of the "Providing Health Quality Care" domain and focuses on structured medication reviews. It includes 3 main indicators, each broken down by several components.


SMR-01 - focuses on proving structured mediation reviews for priority patients. 


SMR-01A - looks at patients at risk of harm due to medication errors receiving a structured medication review. Patients defined as at risk of harm are as follows: 

  • Patients aged 65 or over prescribed an oral NSAID and not prescribed a gastroprotective.
  • Patients aged 18 or over with a history or peptic ulceration prescribed an oral NSAID.
  • Patients aged 18 years or over with a history or peptic ulceration prescribed an anti-platelet.
  • Patients aged 18 years or over prescribed both an oral anticoagulant and oral NSAID within 28 days of each other.
  • Patients aged 18 years or over prescribed both an oral anticoagulant and an anti-platelet within 28 days of each other.
  • Patients aged 18 or over prescribed both an aspirin and another type of anti-platelet within 28 days of each other.
  • Patients aged 18 or over with an unresolved heart failure diagnosis prescribed an oral NSAID. 
  • Patients aged 18 or over with an eGFR of less than 45ml per minute prescribed an oral NSAID.  
  • Patients aged 18 or over with an unresolved asthma diagnosis prescribed a non-selective beta-blocker.


Each cohort should have received at least one structured medication review in the current fiscal year. The indicator will exclude patients receiving end of life care and those patients that choose not to receive the intervention.


SMR-01B - includes patients living with severe frailty and to receive at least one structured medication review. It will exclude patients receiving end of life care and those patients that choose not to receive the intervention. 

 

SMR-01C - includes patients that are using potentially addictive medicines receiving a structured medication review.  Addictive medicines defined in this criteria are as follows:

  • Cohort 1: patients with 2 or more prescriptions over a 3 month period using any of the following medicines - Gabapentinoids, Benzodiazepines, Z-drugs and any oral or transdermal opioid (except weak opioids or heroin substitutes).
  • Cohort 2: patients with a single prescription for an oral transdermal opioid with >120 mg oral morphine equivalent. 

Each cohort should have received at least one structured medication review. There are certain patients excluded from the above cohorts, particularly cancer patients.

 

SMR-01D - looks at care home patients receiving a structured medication review. Personalised care adjustments (exceptions) can be applied for patients that decline an offer of a structured medication review. 

 

SMR-02 - focuses on the identification of people at risk of gastric bleed and aims at reducing that risk with suitable medication.

 

SMR-02A -includes patients prescribed both a NSAID and oral anticoagulation and to either prescribe a gastroprotective medication or no longer prescribe NSAID. 

 

SMR-02B - includes patients 65 years and over or those patient over prescribed a NSAID to either prescribe a gastroprotective medication or no longer prescribe NSAID. 

 

SMR-02C - includes patients prescribed both an oral anticoagulant and another anti-platelet and to either prescribe a gastroprotective medication or no longer prescribe an anti-platelet. 

 

SMR-02D - includes patients prescribed aspirin and another anti-platelet and to either prescribe a gastroprotective medication in addition to aspirin or no longer prescribe an aspirin and/or anti-platelet. 

 

SMR-03 - focuses on dose optimisation of DOACs based on current renal function and aims at reducing the risk of unintentionally prescribed overdoses.

 

Achievement  


IndicatorPointsThreshold
SMR-01A - Percentage of patients at risk of harm due to medication errors who received a Structured Medication Review26LT - 44%
UT - 62%
SMR-01B - Percentage of patients living with severe frailty who received a Structured Medication Review9LT - 44%
UT - 62%
SMR-01C - Percentage of patients using potentially addictive medicines who received a Structured Medication ReviewLT - 44%
UT - 62%
SMR-01D - Percentage of permanent care home residents aged 18 years or over who received a Structured Medication ReviewLT - 44%
UT - 62%
SMR-02A- Percentage of patients aged 18 years or over prescribed both a Non-Steroidal Anti-Inflammatory Drug (NSAID) and an oral anticoagulant in the last three months of the previous financial year, who in the three months to the reporting period end date were either (i) no longer prescribed an NSAID or (ii) prescribed a gastroprotective in addition to both an NSAID and an oral anticoagulant4LT - 85%
UT - 90%
SMR-02B -Percentage of patients aged 65 years or over prescribed a Non-Steroidal Anti-Inflammatory Drug (NSAID) and not an oral anticoagulant in the last three months of the previous financial year, who in the three months to the reporting period end date were either (i) no longer prescribed an NSAID or (ii) prescribed a gastroprotective in addition to an NSAID.4LT - 85%
UT - 90%
SMR-02C - Percentage of patients aged 18 years or over prescribed both an oral anticoagulant and an anti-platelet in the last three months of the previous financial year, who in the three months to the reporting period end date were either (i) no longer prescribed an anti-platelet or (ii) prescribed a gastroprotective in addition to both an oral anticoagulant and an anti-platelet.4LT - 75%
UT - 90%
SMR-02D - Percentage of patients aged 18 years or over prescribed aspirin and another anti-platelet in the 3 months to 1 April 2022, who in the last three months of the previous financial year, who in the three months to the reporting period end date were either (i) no longer prescribed aspirin and/or no longer prescribed an anti-platelet or (ii) prescribed a gastroprotective in addition to both aspirin and another anti-platelet.4LT - 75%
UT - 90%
SMR-03 - Percentage of patients prescribed a direct oral anti-coagulant, who received a renal function test and a recording of their weight and Creatinine Clearance Rate, along with a recording that their DOAC dose was either changed or confirmed (not changed).13LT - 50%
UT - 75%


Monitoring Network DES Activity for SMR

Navigate to the Population Reporting module > Ardens Searches > 5.3 Ardens National Cntrct Reports > Network Contract DES (NCD) > a. Investment and Impact Fund (IIF) 


The Work done folder will show practice achievement.

 

The Work to do folder will identify outstanding work to be done:



For each TO DO search click on the "Population Included" tab to view the list of patients.

 

Supporting Ardens Resources

To support staff recording activity for structured medication reviews, the Ardens 'Structured Medication Review' template is available. 



The medication review tab to capture this information for Care Home patients, is available in the Ardens 'Care Home Review' template.



If you require any further assistance on the process above, please contact Ardens support on: support-emis@ardens.org.uk