Excel Data Forms by cua11779

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									                                                                 Audit of Oral Methotrexate
There are four excel data forms contained within this file which are accessed by clicking on the relevant tab at the bottom of the spreadsheet:-


A: Pharmacy Questionnaire requests information in relation to your pharmacy practice, which you are asked to complete in as much detail as you can.

B: Patient Data Collection Sheet relates to patients who present with a prescription for oral methotrexate within the time frame of the audit, 1 October
2008 to 31 December 2008.

C: Analysis of Data Table provides basic analysis of Form B to assist you in your reflective action plan.

D: Reflective Action Plan relates to reflection on your current practice and provides a template action plan.


Before undertaking this audit you will need to save this file to a location on your computer where you can then access it for data input.

How to complete data input

A: Pharmacy Questionnaire
> To access the form click on the tab at the bottom of the spreadsheet labelled 'A Pharmacy Questionnaire'.

> Answer each question in as much detail as you can. Your answer for each question should be inserted into the right hand column, alongside each question.
> Remember to save the spreadsheet once completed.

B: Patient Data Collection Sheet
> To access click on the tab at the bottom of the spreadsheet labelled 'B Patient Data Collection Sheet'.

> This form should be completed for all oral methotrexate prescriptions presented in the time frame of the audit (1 October 2008 to 31 December 2008).
> The spreadsheet has been split and numbered into 10 columns, each representing a different patient.
> Data should be entered vertically for each patient in a coloured cell. For example, for patient 1, click in cell B5 (yellow cell), under patient identification 1
and alongside the first question, type in the relevant answer. Use the down arrow on the keyboard to go to the next question. Continue in this way until all
the question s for patient 1 have been answered. then repeat the process for the next patient.
> Where the question requests a 'yes' or 'no' answer, please type in 'y' or 'n'. This is important as the spreadsheet has been designed to calculate the
number of 'y' and 'n' asnwers for each question. Some questions may not be applicable for instance questions relating to the patient monitoring booklet if
you have been unable to check the patient monitoring booklet. For these questions please type 'na'.
> Where the question asks, for example, number of weeks supply prescribed, please type in the number of weeks.
> Where there are questions relating to folic acid, if this isn't included on the same prescription as the methotrexate or if a separate prescription for folic acid
isn't presented at the same time, could you please look at your Patient Medication Record (PMR) and base your questions/responses on what appears there.
> If a patient has not been provided with a Patient Monitoring Booklet, please refer them back to their prescriber.

> If the patient hasn't been provided with a patient information leaflet and they would like a copy, please advise them that a copy can be obtained from their
GP. A copy of the patient information leaflet is attached as appendix 6 of the protocol sent to you and can also be accessed from the NPSA website.
> Remember to save the spreadsheet once completed.
> If more than 10 patients present with a prescription within the time frame of the audit, please contact adele.spence@nhsleeds.nhs.uk (telephone 0113
3057639) so that I can alter your spreadsheet to accommodate additional patients. The spreadsheet is password protected to prevent formulae being
accidentally deleted so you will not be able to amend the spreadsheet yourself.

C: Analysis of Data Table
> To access click on the tab at the bottom of the page labelled 'C Analysis of Data Table'
> You do not need to enter any data on this form your answers for the yes and no questions on Form B have been added up and a percentage given
alongside each question


D Reflective Action Plan
> To access click on the tab at the bottom of the page labelled 'D Reflective Action Plan'.
> Please examine you answers given in Forms A and B and use the results in form C to identify any areas where improvements are required in order to meet
the NPSA guidance. The action plan may require action from other healthcare professionals in order to meet the guidance.
> Your answers for the first four questions should be inserted into the right hand column alongside each question. To type in your answer double click in the
box.
> Please complete the action plan template with the actions that are required.
Remember to save the spreadsheet once completed.

Once the audit and action plan is complete please forward to gazala.khan@nhsleeds.nhs.uk
Any queries relating to this spreadsheet please contact Adele Spence on adele.spence@nhsleeds.nhs.uk, tel 0113 3057639 (please note I am on annual leave
from 1 October 08, returning 23 October 08.)
Methotrexate Audit: PHARMACY QUESTIONNAIRE
                                                                                         Please indicate Y or N in the box below
1. Has the dispensing software programme used by the pharmacy been
updated with the latest software which includeds oral methotrexate alerts
and prompts?

                                                                                             Please specify in the box below
2. If no, will your IT software be updated wit methotrexate safety
features?



3. What strength methotrexate (MTX) tablets do you currently              stock?         Put Y or N in the relevant box/es below


   2.5mg only
   10mg only
   Both

4. If both strengths are stocked are they distinguishable in                            Please indicate Y or N in the box/es below
   shape
   size
   colour

                                                                                         Please indicate Y or N in the box below
5. Does the packaging contain the cautionary wording required by the
Medicines & Healthcare products Regulatory Agency (MHRA)? I.e.
advising patients of blood test monitoring and action to take if they have
signs of infection, especially a sore throat

                                                                                         Please indicate Y or N in the box below
6. If strength of tablet is not indicated on a prescription for methotrexate
ie weekly dose only indicated, how do you usually decide what strength
methotrexate tablets to provide?
Provide the strength previously dispensed (by checking the Patient medication
Record)
Ask the patient/carer what strength the patient usually has

Check with the prescriber.
Ask to see the patient's Monitoring Booklet for confirmation.
Provide the strength resulting in the least number of tablets needed to be taken e.g.
if a weekly dose is 10mg choose to provide 10mg strength tablets at one tablet a
week dose rather than 2.5mg tablets at four tablets a week

Other?
                                                                                Please indicate Y/N in the box below
7. If it isn't stated on the prescription, do you include the day of the week
that the weekly dose is to be taken on the label?

                                                                                  Please specify in the box below
8. Do you ask if the patient can manage to open child resistant bottle
caps if loose tablets are dispensed or if they can pop out tablets from a
foil strip pack if dispensed in cartons?




                                                                                  Please specify in the box below
9. If you supply non child resistant bottle caps how do you record this
fact?




                                                                                  Please specify in the box below
10. How do you check if patients are aware of the signs of methotrexate
toxicity or intolerance?




                                                                                  Please specify in the box below
11. How do you ensure that your pharmacy staff are aware of MTX danger
symptoms and respond appropriately to requests for Over The Counter
(OTC) medicines from patients taking MTX?




                                                                                 Please specify in the box below
12. Did you attend the collaborateive event on methotrexate on
30/04/08 at Thackray Medical Musuem?




                                                                                 Please specify in the box below
13. Did you find the event useful?



                                                                                                    5646

                                                                  Please specify in the box below
14. Following the event have made any changes to your practice?




Pharmacy Code:
Audit of Oral Methotrexate - Patient Data Collection Sheet (please provide answers in the coloured boxes alongside the questions for each patient)
Patient ID                                                          1            2             3            4            5              6                              7              8              9             10


a) Please indicate type of prescription form :
                                                                       Please Enter 1 Please Enter 1 Please Enter 1 Please Enter 1 Please Enter 1 Please Enter 1 Please Enter 1 Please Enter   Please Enter   Please Enter
                                                                       to 3 Below     to 3 Below     to 3 Below     to 3 Below     to 3 Below     to 3 Below     to 3 Below     1 to 3 Below   1 to 3 Below   1 to 3 Below
1)FP10 2) FP10HP 3) other - please specify


If other please specify:


b) Does the prescription state as directed? Please indicate Y/N


c) Is the dose stated on the prescription? Please indicate Y/N


d) Is the dose frequency stated on the prescription? Y/N

e) Is the day of the week that MTX is to be taken stated on the
prescription? Please indicate Y/N


f) Is MTX tablet strength indicated on the prescription? Y/N


g) If yes, 2.5mg or 10mg? Please indicate


h) Please insert number of weeks supply prescribed.


i) Were you able to check the Patient Monitoring booklet? Y/N


j) Is the monitoring booklet up to date in terms of:-
MTX strength? Please indicate Y/N or NA


k) dose frequency? Please indicate Y/N or NA


l) Day of the week methotrexate to be taken? Y/N or NA

m) Is the blood testing up to date in the monitoring booklet? Y/N or
NA


n) If no monitoring booklet available has the patient had a recent
blood test for MTX? Y/N or NA
Patient ID                                                           1   2   3   4   5   6   7   8   9   10


Did you label the medication for MTX in terms of:-
o) - strength of dose? Please indicate Y/N


p) - number of tablets? Please indicate Y/N


q) - weekly frequency? Please indicate Y/N



r) Is folic acide prescribed? Please indicate Y/N

s) Is folic acid to be taken at the same time as oral metotrexate?
Pleae indicate Y/N



t) Has the patient been shown how to distinguish between the oral
methotrexate packing and folic acid packaging? Y/N or NA



u) Has the patient been shown how to distinguish between the oral
methotrexate tablets and folic acid tablets? Y/N or NA

v) Has the patient been provided with an up to date MTX Patient
Information Leaflet? Please indicate Y/N.



w) Do you keep OTC records for this patient? Please indicate Y/N




Pharmacy code:
1
Methotrexate Audit: Data analysis table - No need to enter data - the formulae will provide the answers
Total Number of Patient Prescriptions Audited                            0
                                                                                                                                                      Number of 'na'
                                                                                           Percentage "yes"                        Percentage "no"    answers
                                                                     Total "yes" answers   answers for this   Total "No" answers   answers for this   where
                                                                     for this question.    question"          for this questions   question           applicable
b) Does the prescription state as directed? Y/N                                 0                 #DIV/0!                0                #DIV/0!

c) Is the dose stated on the prescription? Y/N                                0                  #DIV/0!               0                  #DIV/0!

d) Is the dose frequency stated on the prescription? Y/N                      0                  #DIV/0!               0                  #DIV/0!

e) Is the day of the week that MTX is to be taken stated on the
prescription? Y/N                                                             0                  #DIV/0!               0                  #DIV/0!

f) Is MTX tablet strength indicated on the prescription? Y/N                  0                  #DIV/0!               0                  #DIV/0!

i) Were you able to check the Patient Monitoring booklet? Y/N                 0                  #DIV/0!               0                  #DIV/0!

j) Is the monitoring booklet up to date in terms of:-
MTX strength? Y/N                                                             0                  #DIV/0!               0                  #DIV/0!           0

k) dose frequency? Y/N                                                        0                  #DIV/0!               0                  #DIV/0!           0

l) day of the week methotrexate to be taken? Y/N                              0                  #DIV/0!               0                  #DIV/0!           0

m) Is the blood testing up to date in the monitoring booklet? Y/N             0                  #DIV/0!               0                  #DIV/0!           0

n) If no monitoring booklet available has the patient had a recent
blood test for MTX                                                            0                  #DIV/0!               0                  #DIV/0!           0



Pharmacy Code:
                                                                                               Percentage "yes"                        Percentage "no"
                                                                         Total "yes" answers   answers for this   Total "No" answers   answers for this   Number of 'na'
                                                                         for this question.    question"          for this questions   question           answers
Did you label the medication for MTX in terms of:-
o) strength of dose? Y/N                                                          0                  #DIV/0!               0                  #DIV/0!

p) number of tablets? Y/N                                                         0                  #DIV/0!               0                  #DIV/0!

q) weekly frequency? Y/N                                                          0                  #DIV/0!               0                  #DIV/0!

r) Is folic acide prescribed? Y/N                                                 0                  #DIV/0!               0                  #DIV/0!


s) Is folic acid to be taken at the same time as oral metotrexate? Y/N            0                  #DIV/0!               0                  #DIV/0!

t) Has the patient been shown how to distinguish between the oral
methotrexate packing and folic acid packaging? Y/N                                0                  #DIV/0!               0                  #DIV/0!           0

u) Has the patient been shown how to distinguish between the oral
methotrexate tablets and folic acid tablets? Y/N                                  0                  #DIV/0!               0                  #DIV/0!           0

v) Has the patient been provided with an up to date MTX Patient
Information Leaflet? Y/N.                                                         0                  #DIV/0!               0                  #DIV/0!

w) Do you keep OTC records for this patient? Y/N                                  0                  #DIV/0!               0                  #DIV/0!



Pharmacy Code:
Methotrexate Audit: REFLECTIVE ACTION PLAN

                                          Please answer in the box below
Did you identify areas in your practice
where you can make changes to help
meet the NPSA advice/guidance? Yes
or No?
If yes, what changes will you make in
the future?




Did you identify areas in the practice
of others eg GPs, nurses or hospital
Drs/Nurses or Pharmacists, where
they can make changes to help meet
the NPSA advice/guidance? Yes or No?

If yes, please list opposite.




 What steps will you take to achieve these changes and communicate changes required in
   the practice of others? Please demonstrate actions required using the table below



Action Identified                         Target completion
                                          date              Nominate Lead   Date completed




pharmacy code:

								
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