PrescQIPP

Technician lead SGLT2i Reviews – Safe Prescribing and Patient Education (2025)

Nottingham West Primary Care Network

Project summary

Sodium glucose co-transporter 2 inhibitors (SGLT2i) have become an established group of medicines used in Type 2 diabetes, heart failure with reduced ejection fraction and chronic kidney disease.
Dosing of the individual medications is dependent on the licensed indication and a patient’s estimated glomerular filtration rate. There are significant risks associated with their use eg diabetic ketoacidosis, Fournier’s gangrene making patient education essential. Patients also need to understand when to temporarily stop taking this medication if they become acutely unwell and the reasoning as to why and equally when to then restart it ie “Sick Day Rules”

Following a report of Fournier’s gangrene in a patient registered with one of our member practices it was noted that recording of patient counselling was patchy, inconsistent and varied considerably with indication and across practices.

Our team of pharmacy technicians were identified as ideal in being able to review patient records to cross check indication against prescribed dose ensuring up to date renal monitoring and to subsequently provide key information around side-effects and sick day rules on an individual patient basis. Consultations were undertaken either face-to-face or via the telephone, relieving workload from the GP, Clinical Pharmacist and Nursing teams in conjunction with PCN approved standard operating procedures. Documentation in the clinical record utilised auto consultations to ensure clear complete coded entries. A mix of pre-booked appointments and cold calls were undertaken according to individual practice working patterns. Patients who proved difficult to get hold of were sent information via text and provided with a link to book a pharmacy technician appointment directly if they wanted to discuss further.

The following summarizes the results to date 6 months post initiation.

No of patients with SGLT2i on repeat 

  • Sep 24 - 2022 
  • Mar 25 - 2179

Percentage of patients with SGLT2 linked to a read code

  • Sep 24 - 68.8%
  • Mar 25 - 72.3% 

Percentage of patients with eGFR in last 12 months

  • Sep 24 - 95.5%
  • Mar 25 - 96.9%

Sick day rules read coded

  • Sep 24 - 75.7%*
  • Mar 25 - 93.5%

Fournier's gangrene education read coded

  • Sep 24 - 46.0%
  • Mar 25 - 89.1%

Education about ketoacidosis read coded

  • Sep 24 - 38.3%
  • Mar 25 - 82.7%

All 3 of the above codes visible

  • Sep 24 - 37.8%
  • Mar 25 - 82.3%

 

  • Initial baseline figure may relate to other drugs where sick day rules had been given eg ACE / ARB / NSAIDs / metformin and not solely SGLT2i

*Feedback from patients has been positive and several side-effects affecting compliance eg persistent thrush, identified and addressed with support from GPs.

The small team of pharmacy technicians has embraced the project despite the daunting patient numbers and have enjoyed the autonomy this project has given them.