33REDUCING MEDICATION-RELATED HARM FROM GABAPENTINOIDS IN PRIMARY CARE: A QUALITY IMPROVEMENT PROJECT WITH A COMPLETED PDSA CYCLE

Abstract

Background: Gabapentinoids, namely pregabalin and gabapentin, are increasingly being prescribed in primary care. Associated adverse effects include delirium, increased falls, dependence and death (E Morrison, E Sandilands, D Webb; Journal of the Royal College of Physicians of Edinburgh; 2017; 47: 310-3). The British National Formulary (BNF) indicates that gabapentinoids are licensed for use in epilepsy and peripheral neuropathic pain, whilst unlicensed uses include migraine prophylaxis and menopause (Joint Formulary Committee; British National Formulary; 2018; 76: 314, 322). Introduction: Airedale Clinical Commissioning Group reported that 2% of patients registered at Haworth Medical Practice were taking gabapentinoids. Issues were raised concerning medication-related harm associated with gabapentinoids. The aim was to reduce prescribing at the practice by 10% in one year. Method(s): In May 2018 there were 144 patients prescribed regular gabapentinoids at Haworth Medical Practice. Prescription charts of a randomised sample (n = 30) were accessed to ascertain whether indications were listed by the BNF. Result(s): Only one third of patients were prescribed gabapentinoids for indications listed by the BNF, and two-thirds were taking them for alternate conditions including fibromyalgia and non-specific pain. Intervention(s): The data was presented to the practice GPs and nurse prescribers. They received an educational leaflet about medication-related harm associated with gabapentinoids, and were encouraged to reflect on their own practice to reduce inappropriate prescribing. The practice pharmacist and two social prescribers provided support with deprescribing to implement the quality improvement. After five months, the number of patients prescribed gabapentinoids was reviewed and this had fallen by 9.7%. In order to sustain this, next steps will involve education for patients and clinicians about managing chronic pain including non-pharmacological therapy options. Conclusion(s): This quality improvement project demonstrated that gabapentinoids are over-prescribed for a variety of uses not listed in the BNF. Given the harm associated with these drugs, perhaps education regarding de-prescribing and improved utilisation of social prescribing for chronic pain would be beneficial.