Clinical audit suggestions: non-steroidal anti-inflammatory drugs (NSAIDs)

Standards

There are long-standing and well recognised gastrointestinal and renal safety concerns with all non-steroidal anti-inflammatory drugs (NSAIDs). There is also an increased risk of cardiovascular events with many NSAIDs, including COX-2 inhibitors and some traditional NSAIDs. The Medicines and Healthcare products Regulatory Agency (MHRA) recommends that the lowest effective dose of any NSAID should be prescribed for the shortest time necessary for control of symptoms. 

The National Institute for Health and Care Excellence (NICE) has produced advice [KTT13] on prescribing NSAIDs based on the evidence base.

Drug safety update

The MHRA issued a drug safety update in June 2013, entitled Dicolfenac: new contraindications and warnings

Audit criteria

• All patients prescribed NSAIDs should have a review of the appropriateness of the prescription on a routine basis, especially in people who are at higher risk of both gastrointestinal and cardiovascular morbidity and mortality (for example, older people).
• All patients over 45 years old prescribed NSAIDs should be co-prescribed a proton pump inhibitor in accordance with NICE clinical guidelines.
• All patients prescribed NSAIDs on a repeat/automatic prescription should have an annual record of their renal function (eGFR and creatinine).
• All patients prescribed NSAIDs on a repeat/automatic prescription should have an annual record of their blood pressure.

Resources

Search for patients on repeat/automatic NSAIDs (BNF 10.1.1)