E008 NSAID safety in rheumatology clinic: a quality improvement project in rheumatology

Background/Aims A vast number of rheumatology patients are prescribed NSAIDs to help manage chronic pain related to arthritis, fibromyalgia and soft tissue rheumatism. NSAIDs carry significant gastrointestinal adverse effects. NICE guidelines recommend routine proton pump inhibitor (PPI) co-prescription with NSAIDs, especially in people above 45 years of age. The aim of our QI project was to assess the current NSAIDs and PPI prescribing practices and to improve PPI co-prescription with NSAIDs to 80% by December 2025 in Rheumatology Clinics at Basildon University Hospital, UK. Methods We carried out a retrospective audit of outpatient clinic letters from August 2022 to January 2023, using the electronic health records. We collected relevant data on demographics, diagnoses, medication prescriptions and adverse effects using an Excel tool. We formulated the QI project on PDSA methodology with a plan to provide teaching on safe use of NSAIDs prescribing, roll out changes in out-patient rheumatology clinics, and re-audit the practices of co-prescribing PPIs with NSAIDs in a year’s time. Results Ninety-one patient records were analysed and 52 patients shortlisted for further data collection. The median age was 49 years (range 22-88), with 31 (59.6%) women. Osteoarthritis was the most common diagnosis in 21 patients, followed by rheumatoid arthritis in 14 patients. Paracetamol was used by all 52 patients (100%), and naproxen was prescribed in 34/51 patients (67%). Co-prescription of PPI with NSAIDs was done in 19/51 (37%) patients, with 32 patients (63%) having no gastro-protection. One patient developed a small bowel ulcer and had to stop NSAIDs. The findings are summarised in Table 1. Conclusion This project showed that the majority of patients prescribed NSAIDs were not protected with a PPI, exposing them to avoidable gastrointestinal risk. Improved documentation of NSAIDs and PPI dose, duration and adverse effects in GP clinic letters should be the norm as it improves communication with primary care. Patients should be offered non-pharmacological ways to manage pain to reduce reliance on NSAIDs. We will also explore the option of electronic prompts while prescribing NSAIDs as we roll out a new EPR system. We aim to educate the clinicians within our department and re-audit in one year’s time to measure any gaps in clinical practice. Disclosure K.K. Garg: None. S. Rashid: None. A. Nandagudi: None.