Safe Prescribing of Methotrexate – A Completed Audit Loop
A. Hollywood, C. O’Keefe, J. Boggs, B. Hanley, S. Collins, C. Feighery
Dermatology Department, Our Lady of Lourdes Hospital Drogheda
Methotrexate(MTX) is a potent immunosuppressant used in the treatment of a variety of rheumatological, dermatological and oncological conditions. MTX is a safe and efficacious drug if used correctly, however, incorrect prescribing, dispensing and use of methotrexate can result in significant patient morbidity and mortality due to severe adverse effects. In order to avoid errors the Pharmaceutical Society of Ireland (PSI) Guidelines recommend that methotrexate prescriptions should include 2.5mg dosing, number of tablets, total dose and weekly intervals. Specifying the day of intake is also encouraged. Methotrexate should also always be prescribed in conjunction with folic acid.
To retrospectively review prescriptions of methotrexate in our dermatology department.
We audited MTX prescriptions from January 2016 - July 2018 according to the PSI guidelines.Two interventions were then implemented; 1) consultant led education on MTX prescribing errors, 2) Example of correctly prescribed methotrexate placed in clinic rooms. We then re-audited MTX prescriptions from July 2018 - December 2018 to complete the audit loop.
120 MTX prescriptions were reviewed. 53 errors were identified on 34 prescriptions. 2 prescriptions did not include total dose. 20 prescriptions did not instruct 2.5mg tablets to be dispensed. 28 prescriptions did not outline number of tablets to be dispensed. One prescription did not include day of intake or weekly dosing. 3 prescriptions did not include a prescription for folic acid. Following the implementation of our 2 interventions a further 30 prescriptions were audited. Only 1 error was identified.
There was a significant reduction in prescribing errors of MTX, from 23% to 3%, following our intervention. This highlights the importance of focused senior-led education on high-risk error-prone areas of prescribing in conjunction with visual examples of correct prescribing.