Community pharmacy teams offered advice and made “significant clinical interventions” over 30,000 times during a seven-month NHS audit focusing on patients taking oral anticoagulant medications.

The audit ran from September 1 2021 to March 31 2022 as part of the Pharmacy Quality Scheme (PQS) and saw 9,903 participating pharmacies submit data for 131,526 patients.

NHS England’s analysis of the audit, published on Monday March 27, says: “Pharmacy teams provided advice and made significant clinical intervention preventing potential harm for patients at increased risk of harm 33,173 times throughout the course of this audit, showing they have a real role to play in educating and managing patients who are prescribed these high-risk medicines.”

Despite a "very small minority" of patients (four per cent) being unaware they were prescribed an anticoagulant, NHSE said the audit indicates that safety requirements “are still not being fully met” and that there was “significant scope” for local multidisciplinary teams to collaborate. 

Almost one in four patients were unable to describe the signs or symptoms of over-anticoagulation, while eight per cent were unaware that they need to consult a doctor or pharmacist before taking over the counter medicines (95.5 per cent of these patients were counselled on interactions with OTC medicines during their pharmacy consultation).

Of the 6,021 patients (4.6 per cent) who were prescribed both an anticoagulant and an antiplatelet, 748 (12.4 per cent) were not prescribed any gastrointestinal protection. Pharmacy interventions saw a further 217 patients given a prescription for GI protection and 33 patients taken off one or both medicines.

Meanwhile, 1,201 (0.9 per cent) of patients were prescribed both an anticoagulant and an NSAID. Following a pharmacy consultation, 151 of these patients had one or both medicines stopped by their GP.

Just one in five patients were carrying their yellow anticoagulant card with them at the time of their pharmacy consultation. NHSE suggested that offering the card in “a digital form” could “increase patient engagement”. 

“There has been no improvement in patient knowledge since the audit completed by pharmacy teams in 2017/18,” said NHSE. It made a number of recommendations for pharmacy teams, including “proactively” discussing medicines with the patient and recording advice given and referrals made using the PMR. 

At the time of the audit, the three most commonly prescribed OACs were apixaban (41.4 per cent) rivaroxaban (25.2 per cent) and warfarin (20.8 per cent). This marked a shift from the 2017-18 audit, when warfarin accounted for 48 per cent of prescriptions.

Fifty per cent of consultations took place with the patient in the pharmacy, while 35 per cent were conducted over the phone, with others taking place via alternative means such as speaking to a patient representative.