Skip to main content

Prototype Prescribing Outlier Dashboard for NHS Bath And North East Somerset, Swindon And Wiltshire CCG

At OpenPrescribing we are piloting a number of data-driven approaches to identify unusual prescribing and collect feedback on this prescribing to inform development of new tools to support prescribers and organisations to audit and review prescribing. These pilot results are provided for the interest of advanced users, although we don't know how relevant they are in practice. There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at [email protected]. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

This report has been developed to automatically identify prescribing patterns at a chemical level which are furthest away from “typical prescribing” and can be classified as an “outlier”. We calculate the number of prescriptions for each chemical in the BNF coding system, the count of all prescriptions within that chemical's BNF subparagraph, for prescriptions dispensed between June 2021 and December 2021. We then calculate the ratio of these counts along with the mean and standard deviation of those ratios across all CCGs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given CCG is from the population mean. We then rank your “z-scores” to find the top 10 results where prescribing is an outlier for prescribing higher than its peers and those where it is an outlier for prescribing lower than its peers.

For each outlier chemical, a kernel density estimation plot of all CCG's chemical:subparagraph ratios is provided, with this CCG's ratio overlaid in red.

It is important to remember that this information was generated automatically and it is therefore likely that some of the behaviour is warranted. This report seeks only to collect information about where this variation may be warranted and where it might not, to inform research on this topic. Our full analytical method code is openly available on GitHub here.

This is a new, experimental feature. We'd love to .

Prescribing where NHS Bath And North East Somerset, Swindon And Wiltshire CCG is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other oral ulceration and inflammation preparations 1 Drugs for oral ulceration and inflammation 3,244 0.00 0.00 0.00 10.20
Nitazoxanide 1 Some other antibacterials 1,748 0.00 0.00 0.00 10.20
Efavirenz 4 HIV infection 14 0.29 0.00 0.03 8.72
Cefotaxime sodium 1 Cephalosporins 8,425 0.00 0.00 0.00 8.04
Lamivudine and zidovudine 4 HIV infection 14 0.29 0.01 0.04 7.12
Nalmefene 44 Alcohol dependence 766 0.06 0.00 0.01 5.30
Mometasone furoate 150 Corticosteroids (respiratory) 205,778 0.00 0.00 0.00 5.15
Midazolam maleate 468 Drugs used in status epilepticus 743 0.63 0.18 0.09 4.82
Betamethasone sodium phosphate 2,457 Otitis externa 14,305 0.17 0.03 0.03 4.71
Diphenhydramine hydrochloride 10 Topical local anaesthetics and antipruritics 2,975 0.00 0.00 0.00 4.21

Prescribing where NHS Bath And North East Somerset, Swindon And Wiltshire CCG is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Midazolam hydrochloride 269 Drugs used in status epilepticus 743 0.36 0.80 0.10 -4.39
Memantine hydrochloride 7,211 Drugs for dementia 34,585 0.21 0.41 0.09 -2.28
Alfentanil hydrochloride 9 Opioid analgesics 19 0.47 0.91 0.20 -2.19
Metronidazole 3,311 Metronidazole, tinidazole and ornidazole 3,313 1.00 1.00 0.00 -2.00
Dexamethasone 10,049 Otitis externa 14,305 0.70 0.79 0.05 -1.86
Melatonin 1,725 Hypnotics 70,976 0.02 0.17 0.08 -1.82
Entecavir 3 Chronic hepatitis B 5 0.60 0.93 0.19 -1.75
Amoxicillin 37,779 Broad-spectrum penicillins 48,264 0.78 0.86 0.04 -1.70
Sodium cromoglicate 4,833 Other anti-inflammatory preparations 9,256 0.52 0.66 0.09 -1.64
Betamethasone esters 1,669 Topical corticosteroids 88,910 0.02 0.03 0.01 -1.52