Audit to assess GP awareness and documentation of biologic and DMARD drugs in primary care patient records

Transcription

1 Audit to assess GP awareness and documentation of biologic and DMARD drugs in primary care patient records Queen Elizabeth Hospital Gateshead Shekar P, Goodhead C, Kelly C, Francis G, Bailey AM*, Thompson L, Hamilton J. * South of Tyne and Wear Primary Care Prescribing Advisor

2 Background Subcutaneous methotrexate and biologic agents are usually hospital prescribed Primary care electronic medication systems provide vital information to hospital clinicians If both hospital and GP medications are not entered onto electronic systems risk increases due to Potential drug interactions Potential for side effects to be missed Opportunistic infections may not be sought

3 Background A previous audit in north of Tyne and Wear showed only 14/111 (13%) of patients GP s had correct biologic medication listed A proforma was developed to record hospital prescribed medications on GP systems safely The drug appears on the medication list with the instruction DO NOT DISPENSE HOSPITAL PRESCRIBED DRUG

4 Aim To assess if changes to recording of hospital prescribed medication has improved primary care documentation for Gateshead rheumatology patients

5 Current systems in Gateshead Commenced on drug in clinic Clinic letter to GP Specialist nurse review for patient education Proforma sent to GP GP prescribed dispensed locally DMARD s SC Methotrexate Stable and self injecting Biologics Hospital prescribed, delivered by home care company Within Gateshead: GP shared care, Medication delivered via home care agreement Outside Gateshead: Hospital prescribed, Medication delivered via home care agreement

6 Method 345 patients identified in Oct 2010 from the rheumatology computerised database Patients were receiving a DMARD, biologic agent or both GP practices of 343 patients were contacted by telephone in the following 2 months GP practice staff were asked to use their electronic record to search for listings in the medications list Any mention of these prescriptions in other areas of the patient record were also noted

7 Results - GP Awareness of Subcutaneous Methotrexate

8 Further Results GP practices of the 18% of patients (10/56) on subcutaneous methotrexate (GP prescribed) who were not aware of this were re-contacted 8/10 correctly documented (under Metoject) 2/10 discontinued methotrexate in September/November 2010

9 Results

10 Results

11 Further Results GP Practices of the 8% of patients (9/121) who were not aware of conventional DMARD prescriptions were re-contacted 3/9 had correct medications listed 2/9 correctly only had 1 DMARD listed- rheumatology database not updated since other drug stopped 1/9 was on a different DMARD 1/9 had 1 out of 2 DMARDS listed as the second drug had not been started 2/9 drug still not listed on electronic record

12 Discussion Reasons for discrepancy in results: Delays in communication pathway Staff awareness Individual practice systems Location on electronic record- acute vs. repeats Subcut methotrexate was more likely to appear on the GP electronic record than biologics? Related to a specific shared care agreement Limitation of the audit was long data collection time period due to large volume of patients

13 Developments Electronic communication is being tested to communicate medication changes from hospital to primary care Proforma has been adapted to remove hospital prescribed prescriptions from acute to repeat section of electronic record A macro has been developed that allows a complete medication list to be generated at a particular time point Quarterly audits are now being performed by a practice pharmacist to ensure all medications are correctly listed

14 Conclusions 100% of patients on subcutaneous methotrexate prescribed by the GP had correct documentation on the electronic record, compared to 67% when prescribed by the hospital Less than 50% of patients on biologic monotherapy had medication recorded correctly, leaving an ongoing clinical risk Development of the proforma has improved recording of hospital prescribed medication by GP s but it remains suboptimal

15 Recommendations Re-audit summer 2012 Discuss the possibility of biologic agent prescribing by GP s Optimise communication and sharing of information to maximise patient safety Roll out system to other hospital prescribed medications

16 Medical admissions Hospital clinic A&E Home care company Hospitals out of area Patient GP Private clinic/ hospital Walk in centres Pharmacy

17 Contacts