Community Pharmacy Oral Methotrexate Audit 0809 by tyndale

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									           Community Pharmacy Oral Methotrexate Audit 08/09

Pharmacy Name…………………………………………………Date…………………..

Aim

The aim of this audit is to ensure all patients dispensed oral methotrexate have had their
treatment fully assessed as advised by the National Patient Safety Agency (updated June
2006)

This information will then be shared with GP practices and secondary care.

Rational

Methotrexate was first used, in high doses, to treat cancer but experience over thirty years
has shown that methotrexate at much lower doses is helpful in the treatment of a number
of joint, skin and bowel conditions. Methotrexate is a well established effective treatment
for several different types of rheumatic diseases (for example, rheumatoid arthritis,
psoriatic arthritis, juvenile idiopathic arthritis), severe psoriasis and for bowel diseases (such
as Crohn's disease). It is also used in some other conditions where the body's natural
defence system is overactive.

This audit is designed to

      Ensure that patients prescribed methotrexate receive appropriate verbal and
       written information at the start of therapy.
      Ensure that patients are taking their methotrexate as prescribed by their doctor.
      Ensure that patients are treated in accordance with the Shared care guideline
       issued by the Winchester & Southampton District Prescribing Committee (May 2007
       update - copy enclosed)
      Ensure that the directions state the number of tablets as well as the dose in mg to
       be taken. Additionally that the directions state a specific day of the week or ‘to be
       taken once weekly as a single dose’

Standards ( * based on NPSA/ Shared Care Guidelines )

   1. All patients should have been issued with a methotrexate information and record
      booklet ( target 100%)
   2. All patients should be taking methotrexate at the dose prescribed on their
      prescription ONCE each week (target 100%)
   3. A check has been made for any clinically significant interactions/ side effects and
      patients are aware of signs of toxicity (target 100%)
   4. All patients are receiving regular blood tests in accordance with the shared care
      guidelines (target 100%)
   5. All female patients of child bearing age are aware to protect against pregnancy
      (target 100%)
Data Collection

   1. Select an appropriate period of time, which will result in a minimum of 10 patients,
      who are currently prescribed methotrexate
   2. Complete the attached Data Collection Form, using a different sheet for each
      patient. Please do not add any patient identifiable data, but keep records at the
      pharmacy as it may be necessary to follow patients up.

Results



Please see data collection table attached.




            Table 1. Results showing % compliance with audit standards



STANDARDS                                      No. of patients          % Compliance
                                               adhering to
                                               standards

1. All patients should have been issued with
a methotrexate information and record
booklet.

2. All prescriptions for methotrexate have
the directions stated as the number of
tablets as well as the dose in mg to be
taken. Additionally the directions state a
specific day of the week or ‘to be taken
once weekly as a single dose’

3. A check has been made for any clinically
significant interactions/ side effects and
patients are aware of signs of toxicity

4. All patients are receiving regular blood
tests in accordance with the shared care
guidelines.

5. All female patients of child bearing
age aware to protect against
pregnancy
                              Table 2. Additional Information


Additional item                                No. of patients         % of total

1. No. of prescriptions stating ‘as
directed’ for the dosage instruction

2. Strength of tablets prescribed on the       2.5mg
prescription                                   10mg
                                               mixed
3. No. of patients that methotrexate
   appears on their repeat slip

4. No. of patient recommendations that
have been made as a result of this audit

5. No. of patients referred to their GP as a
result of this audit




Discussion/Conclusion




Actions required /by whom
List any follow up with GP / patient Please do not add any patient identifiable data.
Please complete by March 31st 2009

When you have completed your audit please send a copy of the whole document;
to Pat Bodman, Prescribing Team, Southampton City PCT, 2nd Floor, Moorgreen
Hospital, Botley Road, West End, Southampton SO30 3JB

Tel: 023 8047 5898, Fax: 023 8047 5871

Please retain a copy for your Community Pharmacy Contracts File




* References

National Patient Safety Agency: Improving compliance with oral methotrexate guidelines
Jun 2006
Available at www.npsa.nhs.uk/health/alerts

Shared care guideline for Methotrexate: Winchester & Southampton District Prescribing
Committee GU-058 May 2007

Footnote:

A useful web resource is available containing a template SOP for the dispensing of
methotrexate; ‘Supplying Oral Methotrexate’ SOP is available for members at:
www.npa.co.uk/members




Audit completed by....................................................................Date…………………….

With special thanks to Alliance Pharmacies for the use of their original ideas for this
audit.
Audit designed by Tim Barlow Clinical Governance Facilitator SCPCT March 2008

								
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