A Standards-based Clinical Audit on Safe Prescribing of Combined Oral Contraception at a Local GP Surgery

The Problem:

Combined Oral Contraceptive (COC) is associated with increased risks of adverse events such as venous thromboembolism. Correct prescribing is important to prevent complications associated with its use.

The UKMEC and NICE stipulate that clinicians should perform a risk assessment during every COC consultation, which includes clinical measurements and enquiry about risk factors.

Methods:

This audit reviews COC prescriptions at a local GP surgery and analyses its compliance to national guidelines for safe prescribing.

Using the EMIS database, a retrospective, cross-sectional review of medical notes from 75 patients was conducted. These patients were aged 15-49 years and were prescribed COC between 01/08/2018 and 01/02/2019. High-risk prescriptions described by the UKMEC were identified. 14 parameters of the risk assessment set by NICE (e.g. blood pressure measurement) were studied.

Findings/ Learning:

The practice failed to meet the standards for safe prescribing. 14% of patients were prescribed COC, despite being classed as high-risk. There was substandard documentation in 13 parameters. High-risk prescriptions may lead to adverse events; therefore, alternative contraceptive methods should be recommended. The lack of documentation might further lead to legal litigation.

Why it Matters:

Although this was a small-scale project, issues raised here could help suggest improvements in future practice nationwide. Reasons for substandard documentation include clinicians’ negative attitudes towards a ‘COC template’, prioritisation of a COC clinic as a ‘catch-up time’ rather than a full risk assessment, poor understanding of the guidelines and components of a COC consultation, and over-reliance on own experiences and the EMIS summary page.

Several changes were recommended to ensure safe COC prescribing. They include posters and staff re-training to promote awareness of prescribing safety, the use of pre-consultation questionnaires to allow patients to self-report any contraindications and symptoms before a COC appointment, and enhancing the accessibility and simplicity of the current COC template to guide future risk assessment.

Presenting Author: Joshua Wong, University of Central Lancashire MBBS 5, tsjwong@uclan.ac.uk