An Audit of Orlistat Prescribing in One PCN (2024)
Laura Kyte, PCN Dietitian
Reason for the audit:
To look at adherence to monitoring requirements and overall success with use of orlistat
Criteria or criterion to be measured:
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Weight recorded on initiation
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Weight at 3 monthly intervals
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Stopped if not achieving 5% at three months
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Had patient seen the Dietitian
Standard(s) set:
British National Formulary (BNF)
Preparation and planning:
Student Dietitian assisted in data collection on excel spreadsheet, anonymised. Another staff member helped set out EMIS search.
Data collection:
Date: 19/11/2024
Carried out by: Laura Kyte
Results:
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71 patients recorded as started orlistat in previous 2 years
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80% (57) of prescriptions issued by dietitian, 20% (14) issued by doctor
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No starting weight or BMI for 5 patients:
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3 of whom started by GP
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2 of whom started by Dietitian
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Remaining patients all met the criteria
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Missing weight data at 3 months for 30 patients (42%),
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4 were documented as patient choice to stop orlistat
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2 reviewed and no weight recorded
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The remaining patients did not attend follow up.
For those not attending a 3-month review, prescriptions of orlistat were issued as per below, with no monitoring:
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1 issue of 84 tablets for 13 patients
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1 issue 168 tablets for 1 patient
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1 issue 252 tablets for 3 patients
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2 repeat issues for 3 patients
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3 repeat issues for 3 patients
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4 repeat issues for 1 patient
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9 repeat issues for 1 patient
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15 repeat issues for 1 patient
Standard achieved:
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7% had no starting weight/BMI recorded so unable to assess accurate prescribing.
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The remaining 95% (66 patients) all met criteria for prescribing orlistat
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42% patients did not have a weight recorded at 3 months to assess ongoing eligibility
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30% of patients had further prescriptions despite no weight review
Changes:
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Ensure starting weight recorded in notes for all patients and 5% target.
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Book three-month review with dietitian or send delayed accurx reminder to book nearer the time
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Stop orlistat if patent does not attend a review
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Add note to prescription with date for weight review (patient notes)
Implementing the above changes should result in supportive patient care, and monitoring of patient outcomes, to ensure effective use of medication.
This is an area where a First Contact Dietitian can support capacity in Primary Care and effectively support patients with obesity management.