Evaluation of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) toolkit in community pharmacies in Scotland

An evaluation by University of Strathclyde and Healthcare Improvement Scotland (HIS).


What are NSAIDs?

NSAIDs stands for nonsteroidal anti-inflammatory drugs. They are a group of medicines used to relieve pain, reduce inflammation, and bring down a high temperature. They include drugs such as Ibuprofen, Diclofenac and Naproxen.


What are the safety issues with NSAIDs?

NSAIDs are often associated with emergency hospital admissions and avoidable harm. The most common harms associated with NSAIDs include gastrointestinal ulceration and bleeding, but they can also include heart and kidney complications.


What is the NSAIDs toolkit?

HIS worked with staff across primary care to develop a toolkit with two safety bundles to improve safety for patients taking NSAIDs.

  • Communication care bundle (2018): Supports pharmacy teams to deliver key messages to patients being dispensed or purchasing NSAIDs. ​
  • Safer care bundle (2019) Supports pharmacists to improve the clinical care of patients who take NSAIDs in addition to other medication.​

The toolkit offers a range of practical tools and resources such as safety information cards, till prompts and stickers. Pharmacy teams were also asked to use Quality Improvement (QI) tools which can be used to measure changes and support the implementation of the safety bundles.


Evaluation aims and method

We used online questionnaires for community pharmacy staff and for patients who collect or purchase NSAIDs from a community pharmacy to help us understand:​

  • Are people given advice on NSAIDs safety? ​
  • What do people think about advice given to them on NSAIDs safety? ​
  • Do community pharmacy teams know about the toolkit or safety bundles? ​
  • Have the toolkit or safety bundles helped community pharmacies improve safety practices?


Insights from staff

  • Staff using the toolkit are more likely to use the practical resources (such as the till prompts or stickers).
  • There was limited reported use of the QI tools included in the safety bundles.
  • Staff who have used the bundle report their confidence has increased, and the amount and quality of their advice they offer has improved.
  • Stickers and till prompts were considered helpful by community pharmacy staff.


Insights from those collecting or purchasing NSAIDs

  • There is variation in the delivery of NSAIDs information and advice across community pharmacies.
  • When people do receive advice around NSAIDs safety they find this helpful.
  • From the advice given, people are most likely to take their medication with food.
  • People who have been given advice say they are more likely to go to a pharmacy for advice in the future.


HIS next steps

  • Highlight the need for safety around NSAIDs through existing programmes of work.
  • ​Encourage wider use of the NSAIDs toolkit with community pharmacy teams.​
  • Highlight to pharmacy staff the positive feedback from people who have received advice on NSAIDs safety. ​
  • Keep the NSAIDs toolkit on HIS webpages and promote the use of the safety bundles via the website.


Find out more

If you have any questions, get in touch at his.pcpteam@nhs.scot.