Waller Mark
GPST3 Sheffield Teaching Hospitals Trust.
J Family Med Prim Care. 2022 Nov;11(11):7085-7088. doi: 10.4103/jfmpc.jfmpc_772_22. Epub 2022 Dec 16.
Citalopram is a drug with many important safety considerations in prescribing including dosage adjustments, pre-prescription testing and multiple interactions. Because of this, the UK government issued advice regarding the prescription of citalopram and escitalopram in its Drug Safety Update Vol 5 Issue 5, Dec 2011,[1] and the expectation is that all prescribers adhere to this.
PURPOSE/AIM: To establish the adherence to prescribing guidance of citalopram at the practice level, implement change to address the lack of adherence and then evaluate the effectiveness of the change using re-audit techniques.
Patients were identified using data searching techniques on EMIS for February-April 2020. Parameters searched for included age, hepatic impairment, cardiac disease, known QT prolongation and concomitant use with other QT-prolonging medication. Following the first cycle teaching on the safer use of citalopram was delivered to all prescribers and an EMIS prompt was also set up. A second audit cycle was then carried out. Data was analysed using Statistical Package for Social Sciences software to assess the significance of the results.
Following the presentation of the first cycle findings and the introduction of the EMIS safety prompt, there was a statistically significant reduction in incorrect citalopram dose prescription in the over 65s (8 vs 1), a statistically significant reduction in the incidence of dangerous drug interactions involving citalopram (44 vs 8) and a significant reduction in the incidence of unsafe prescribing of citalopram overall (47 vs 9).
The introduction of an EMIS prompt and one-off prescriber teaching resulted in a statistically significant reduction in incorrect prescriptions of citalopram when re-audited a year later. These interventions resulted in improved patient safety and more effective use of resources and could easily be replicated at other practices throughout the country both for citalopram and other drugs with multiple safety considerations.
西酞普兰是一种在处方开具时存在诸多重要安全考量的药物，包括剂量调整、处方前检测以及多种相互作用。正因如此，英国政府在其2011年12月的《药物安全更新》第5卷第5期[1]中发布了关于西酞普兰和艾司西酞普兰处方的建议，期望所有开处方者都能遵守。
在实践层面确定对西酞普兰处方指南的遵守情况，实施变革以解决缺乏遵守的问题，然后使用重新审核技术评估变革的效果。
在2020年2月至4月期间，利用EMIS上的数据搜索技术识别患者。搜索的参数包括年龄、肝功能损害、心脏病、已知的QT间期延长以及与其他延长QT间期药物的联合使用情况。在第一个周期之后，向所有开处方者提供了关于更安全使用西酞普兰的培训，并设置了EMIS提示。然后进行了第二个审核周期。使用社会科学统计软件对数据进行分析，以评估结果的显著性。
在展示第一个周期的结果并引入EMIS安全提示后，65岁以上人群中西酞普兰剂量处方错误有统计学意义的减少（从8例降至1例），涉及西酞普兰的危险药物相互作用发生率有统计学意义的降低（从44例降至8例），西酞普兰总体不安全处方发生率显著降低（从47例降至9例）。
引入EMIS提示和一次性的开处方者培训，在一年后重新审核时，西酞普兰的错误处方有统计学意义的减少。这些干预措施提高了患者安全性，使资源得到更有效利用，并且对于西酞普兰以及其他有多种安全考量的药物而言，在全国其他医疗机构中都能轻松复制。
