Smarter data, better tools: helping to avoid harm from antipsychotics prescribed for behaviour that challenges in people with learning disability

Health Innovation West Midlands (HIWM), Health Innovation East Midlands (HIEM), NHS England Medicines Safety Improvement Team, Clinical Digital Resource Collaborative (CDRC), The Patient Safety Collaboratives

Project summary

This project shares data resources and tools created as part of a National Medicines Safety Improvement Programme (MedSIP) initiative that aims to ‘help people with a learning disability who are at risk of behaviour that challenges, to avoid harm from psychotropic medicines’.

The MedSIP employs a network-based delivery model to enable national scale; key to success is the use of data insights to drive improvement by using metrics that matter. Prior to our work, extensive national scoping identified no readily available data specific to this population that could be used to support improvement or allow risk stratification of patients.

This project describes co-development of:

• Two unique national improvement metrics that link to measurable harm

  • Long-term Antipsychotic Prescribing Metric: Rate of long-term antipsychotic prescribing, per head of general practice Learning Disability Register, excluding those on the severe mental illness register.

  • Total Antipsychotic Prescribing Metric: The total Oral Risperidone Equivalence (ORE) (milligrams) from a target list of antipsychotic medicines per head of general practice Learning Disability Register, excluding those on the Severe Mental Illness Register

• Three general practice clinical system searches for the above national metrics, including baseline data, which were professionally created, clinically checked, and DTAC compliant.

• Data collation and visualisation tool that drives local improvement and supports national data submission.

• National data dashboard.

The project team collaborated with NHS England’s STOMP/STAMP programme lead, Royal College of Psychiatrists Intellectual Disability Faculty (RCPsych), academic partners, and Clinical Digital Resource Collaborative (CDRC) as a clinical search specialist. The use of ORE in the metric is a translation of a research study (APHID) into routine clinical practice, allowing reduction in dose to be estimated for a population which complements the population number.

These searches and tools have been tested and implemented across England through the wider MedSIP allowing general practices to gain insight they did not previously have into their antipsychotic prescribing practices for people with learning disability, a cohort that experiences well documented and significant health inequalities. These novel metrics feed local and national dashboards, supporting teams across 22 ICBs to improve quality of care and prescribing, reducing the risk of harm from antipsychotic medications. Early indicators show an indicative improvement in data that can be modelled into reduction in severe harm and an improvement in quality of life using number needed to harm figures.

All the searches and tools are easily accessible and free of charge. Improvement support and resources are also available through a dedicated NHS Futures web space for MedSIP