Abstract

A number of Paediatric Rheumatology patients have methotrexate or biologics prescribed by the hospital, via a homecare company. When these patients are admitted to hospital, it was identified that these medicines were poorly recorded in the admission clerking or at the point of medicines reconciliation by pharmacy. This led to near misses across the region, for example, trimethoprim and methotrexate coadministered, severe infections and biologics and NSAID use with unknown concurrent methotrexate. With medicines reconciliation seen as a NICE priority,1 an audit was carried out to identify where this information is recorded and to identify strategies to minimise the risks identified.

The Paediatric Rheumatology team have 54 patients who have subcutaneous methotrexate or biologics prescribed by the hospital consultants. The GPs of these patients were contacted by telephone, in a similar approach that would occur at the point of hospital admission. The GP practices were asked for a faxed copy of the medicines the patients were taking. If this record did not include the hospital prescribed medicine, the GP practice were specifically asked ‘Do they have a record that this patient has medicines prescribed by a hospital?’ It was also confirmed with the homecare company that these patients identified were still having deliveries of the hospital prescribed medicine, and also they had a valid hospital prescription.

Following the initial request for a copy of a patient's medicines record from the GP, 54 records were received. Only one patient's record listed the hospital prescribed medicine as a note on the record faxed. On further questioning, there were 19 records where the GP receptionist stated the hospital prescribed medicine was listed on letters from the hospital and offered to fax copies to me. All 54 patients had received a delivery of medicines within the last 12 weeks, and had current valid prescriptions registered with the homecare company.

After consideration with the multi-disciplinary team, patient education was deemed the cheapest and easiest way of introducing a risk minimisation strategy. This has involved the writing of a patient information leaflet and also a patient held monitoring booklet. The local medicines management team at the PCT were approached to see if there was a method of adding these medicines to the GP computer medicines list. This is hopefully being addressed in the longer term strategy of updating these systems. The issue has also been highlighted on a newsletter, which has been sent to the GPs of the patients identified in this audit. The issue has also been discussed with pharmacy colleagues in adult rheumatology. It was felt the same issue occurs in the adult population, but GPs were starting to take on this prescribing in primary care and also have better coding of the patient's condition on the summary care record.