Locally Commissioned Service 2014/15
Provision (Prescribing and Monitoring) of Methotrexate
for Camden GP practices
Audit Workbook
To be completed and returned to Camdenlcs@nhs.net by 17 April 2015.
METHOTREXATE
Locally Commissioned Service Data Collection Form and AUDIT
Practices need to complete the following sections:
Date of review:
Reviewer:
Position of reviewer:
Do you have a READ coded register?
Yes/No
Main READ code used
Number of patients prescribed oral Methotrexate in last 12 months
Number of patients on the current Methotrexate register
Total number of patients on oral Methotrexate that the practice prescribe AND
monitor for under the LCS
Systems and protocols in place to ensure patients are being monitored for their
bloods?
Yes/No
Prescribers aware of symptoms of toxicity or intolerance
Yes/No
Practice has updated prescribing software meeting IT criteria in the NPSA Alert
Yes/No
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METHOTREXATE Locally Commissioned Service PRESCRIBING AUDIT
Aim of audit:
To establish whether the high risk medicine methotrexate is prescribed and monitored
appropriately in primary care patients.
Audit Criteria
Standard
1
Indication for the drug is documented and read coded
100%
2
If a shared care guideline (SCG) is available it is scanned in or
alternatively a letter from the hospital clinician with dose, details of
monitoring and areas of responsibility etc. is scanned in
80%
3
Monitoring is recorded as per relevant SCG or SPC (SPC
Summary of Product Characteristics – Data sheet)
80%
4
Patient aware of risks and benefits of methotrexate, including what sideeffects to watch out for and what to do if they experience any side-effects.
NB Confirmation of patient’s understanding should regularly be sought,
not just on a one off occasion.
80%
5
Patient and prescriber are aware of the frequency, location and process
of conducting blood tests
80%
6
Methotrexate specified dose is prescribed i.e. (in mg and number of
tablets and NOT “prn” nor “as directed”)
100%
7
Number of patients prescribed 2.5mg tablets
100%
NB: There is a local agreement that only 2.5mg tablets are to be
prescribed. To minimise dosing errors 10mg tablets should NOT be
prescribed.
8
Repeat prescriptions for methotrexate are retained separately for
prescriber review prior to authorising
100%
9
Record of patient held monitoring and information booklet in
computerised medical notes
80%
10 Directions on the prescription are in agreement with the current dosage
instructions confirmed by the latest hospital letter.
100%
11 Quantity of tablets issued is appropriate and not excessive, consistent
with monitoring requirements.
100%
NB: Methotrexate
The dose should be stated in mg and also the number of 2.5mg tablets required. NB: There is a
local agreement that only 2.5mg tablets are to be prescribed. To minimise dosing errors
10mg tablets should NOT be prescribed.
All patients should have a methotrexate monitoring and patient information booklet.
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Audit Process:
STEP 1 - Identification of patients
Search all patients prescribed methotrexate.
STEP 2 - Data collection

Print search (computerised practices) for patients on each drug.

Photocopy data collection form

Complete data collection form using patient records (computerised or manual as appropriate).
STEP 3 - Intervention for individual patients
Whilst completing the data collection form for each patient identify areas for change, implement
changes and document all interventions in patients’ records.
Consider the following interventions:

Clarify whether prescription for these medicines is by primary care or secondary care. If the
latter add note to EMIS re dosing details to ensure interactions are considered when
prescribing new medicines.

If blood test results to monitor these drugs are unavailable establish a regular process for the
patient to attend the practice phlebotomy service or contact the hospital consultant to request
blood test results to ensure adherence to the monitoring requirements.

Ensure patient is familiar with side-effects and the action to take if experiencing a side effect
and the process and importance of monitoring.

Add record to EMIS to review this drug at regular intervals.
STEP 4 - Analysis
Calculate results for the practice. The data collection form has simple yes or no questions and the
answers for each patient should be entered into one column.
For each of the criteria add up the total number of yes’s divide this by the total number of patients
and multiply by 100. Enter the answer into the appropriate summary table column.
STEP 5 – Re-audit
Re-audit to assess the effect of changes implemented. Develop an action plan for improvement.
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METHOTREXATE PRESCRIBING AUDIT - DATA COLLECTION FORM
Practice:
Date of base line audit:
Patient Ref no.
Date of re-audit:
1
2
3
4
Criteria
Total number of patients prescribed methotrexate
1
READ coded indication?
2
SCG or letter from
consultant scanned into
computer
3
Monitoring recorded as
per SCG / SPC
4
Patient aware of side
effects & action to take –
discussed with patient
5
Patient & Prescriber aware
of process for blood tests
6
Specified dose prescribed
7
Prescribed 2.5mg tablets
8
Repeat Rxs retained
separately
9
Record of Patient Booklet
10
Directions in agreement
with hospital
11
Quantity of tablets
appropriate
5
6
7
8
9
10
Enter 1=Yes, 0=No
(Photocopy form as necessary – alternatively an electronic version of this form can be used)
Comments (Action or follow up required)
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HIGH RISK MEDICINES AUDIT - SUMMARY TABLE
Practice:
Audit Criteria
Standard
1
Indication for the drug is documented and read coded
100%
2
If a shared care guideline (SCG) is available it is
scanned in or alternatively a letter from the hospital
clinician with dose, details of monitoring and areas of
responsibility is scanned in
80%
3
Monitoring is recorded as per relevant SCG or SPC
(SPC
Specific Product Characteristics – Data sheet)
80%
4
Patient aware of risks and benefits of methotrexate,
including what side-effects to watch out for and what to
do if they experience any side-effects. NB Confirmation
of patient’s understanding should regularly be sought,
not just on a one off occasion.
80%
5
Patient and prescriber are aware of the frequency,
location and process of conducting blood tests
80%
6
Methotrexate specified dose is prescribed i.e. (in mg
and number of tablets and NOT “prn” nor “as directed”)
100%
7
Number of patients prescribed 2.5mg tablets
100%
Practice
Baseline
%
Practice
Re-Audit
%
NB: There is a local agreement that only 2.5mg
tablets are to be prescribed. To minimise dosing
errors 10mg tablets should NOT be prescribed.
8
Repeat prescriptions for methotrexate are retained
separately for prescriber review prior to authorising
100%
9
Record of patient held monitoring and information
booklet in computerised medical notes
80%
10 Directions on the prescription are in agreement with the
current dosage instructions confirmed by the latest
hospital letter.
100%
11 Quantity of tablets issued is appropriate and not
excessive, consistent with monitoring requirements.
100%
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