CQC have has been informed of a serious incident where a patient on bisphosphonates sustained bilateral atypical femoral fractures due to inadequate monitoring. In response, a new search has been added to the medicines usage bundle to improve prescribing safety and raise awareness of the risks. Bisphosphonates, used to treat or prevent osteoporosis, must be taken correctly and can have serious side effects. Patients should be reviewed 12–16 weeks after starting treatment to check for side effects and ensure compliance, followed by annual reviews. A full reassessment, including consideration of a DEXA scan, is recommended after five years or sooner if clinical risk factors change or a new fracture occurs.

The new searches are:

• On Bisphosphonate – Check as first issued >5 years ago
• On Bisphosphonate – Check as first issued >5 years ago + no DEXA in last 5y

Additionally, The NICE CKS guidance for DOAC (Direct Oral Anticoagulant) monitoring has been updated to recommend more frequent blood tests, particularly for patients over 75 or those with frailty. Patients should have full blood count, renal, and liver function tests on each monitoring visit and at least annually, the frequency being dependent on renal function. For older or frail patients, testing should occur every four months. If creatinine clearance (CrCl) is below 60 mL/min, monitoring frequency should be based on CrCl divided by 10 (for example, every 3 months if CrCl is 30). Additional tests are advised if an intercurrent illness affects kidney or liver function. To support these changes, existing clinical searches have been updated. Standard searches continue to identify at-risk patients but may include slightly extended intervals, while enhanced searches align directly with the updated NICE guidance. Red text highlights the new wording and searches.