ISR Autumn Meeting 2018
Joint 4th Place Award
Dr Stephen McDonald
An audit into the use of Hydroxychloroquine
Stephen McDonald, Julie Ann Henderson. Rosemary Friel, Wing Yau, Philip Gardiner
Department of Rheumatology, Altnagelvin Area Hospital, Western Health and Social Care Trust
The use of Hydroxychloroquine/ Plaquenil (PLQ) in rheumatoid arthritis and connective tissue diseases is long established and evidence based practice. Retinopathy with changes in pigmentation and visual field defects can occur with prolonged use, but appears to be uncommon if the recommended daily dose is not exceeded.
A Boston team developed an iOS App, DoseChecker, to provide a tool for rapid comparison of Actual Body Weight (ABW) and Ideal Body Weight (IBW) hydroxychloroquine dose calculations for a patient at the point of care.
Our primary aim was to review the prescriptions of PLQ within the Rheumatology department, using the DoseChecker app and to modify the prescriptions if indicated.
A secondary objective was to evaluate effectiveness in communicating/documenting advice regarding annual eye-checks in patients on PLQ.
Patients commencing on PLQ and patients currently prescribed PLQ were included in analysis. Data was collected using the attached form (Figure 1). Data obtained included, but was not limited to, diagnosis, age, weight, height, duration of use, current dose regimen, estimated cumulative dose, whether the current regimen was correct when consulting DoseChecker app, newly advised regimen if applicable and documented eye check within the last year.
28 patients already using PLQ were included in the analysis, as well as 3 new start patients. The average age of patient included was 55 years. 27 patients had Rheumatoid Arthritis, 2 Sjogren's, 1 SLE and 1 MCTD (Figure 2). The median duration of use was 4.5 years, with the longest prescription 16.5 years. 4/28 patients had an incorrect dose regimen when checked against the DoseChecker app. The median difference in weekly dosing in those that required correction was 325mg. 6/28 patients had a documented eye check-up advised within the last 12 months. Using the DoseChecker app, 2/3 new start patients on PLQ had their prescription changed from the presumed 200mg bd, leading to a median difference in the weekly dose of 600mg.
The use of the DoseChecker app has led to the amendment of 14% of current PLQ prescriptions and 67% of new prescriptions in this audit. Improvement in documentation pertaining to eye checks is required.