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Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and
Sascha Karlen1, Marc Oertle2, Stefan Weiler3
1Medical Informatics Research Centre, University Hospital Zurich and University of Zurich, Switzerland.
Introduction:
Methotrexate is used to treat many medical conditions with medication schedules that differ widely in dosage and frequency. The high potential of erroneous too frequent low-dose methotrexate prescriptions leading to severe adverse reactions is well known; however, documentation is mainly limited to case reports. We reviewed all methotrexate prescriptions in a secondary and a tertiary care hospital to analyse the incidence of too frequent low-dose methotrexate prescriptions, and assessed the quality assurance concepts implemented.
Methods:
All nononcological low-dose methotrexate prescriptions issued for inpatients within 55 months were analysed to identify too frequent prescriptions potentially leading to harmful overdosing. Subsequently, clinical pharmacologists reviewed all new methotrexate prescriptions with resulting interventions at the physician level in the tertiary care hospital. The impact of an interruptive alert displayed at methotrexate order entry was assessed in the secondary care hospital.
Results:
The incidence of too frequent prescriptions at the tertiary hospital was 1.6% (five medication errors and nine near misses in 888 inpatients). After introducing checks by pharmacologists, two prescription errors were intercepted during the 8 month quality assurance period. At the secondary care hospital the incidence dropped from 2.5% (2/79, 20 months) to 0.8% (1/123, 35 months) after the alert was implemented.
Conclusions:
The incidences of erroneous too frequent low-dose methotrexate prescriptions observed at both hospitals were considered too high due to the high potential for increased morbidity, mortality and costs. Therefore, quality assurance measures were implemented and the preliminary data show a positive impact on patient safety for both approaches.
Insights
Too frequent low-dose methotrexate prescriptions pose a significant risk. Quality assurance measures, including pharmacologist review and electronic alerts, effectively reduced prescription errors and improved patient safety.
Area of Science:
- Pharmacology
- Patient Safety
- Health Informatics
Background:
- Low-dose methotrexate is prescribed for various conditions with diverse dosing schedules.
- Frequent, low-dose methotrexate prescriptions carry a high risk of severe adverse events, though often documented in case reports.
- Analysis of methotrexate prescribing patterns in hospitals is crucial for identifying and mitigating medication errors.
Purpose of the Study:
- To determine the incidence of excessively frequent low-dose methotrexate prescriptions in two hospitals.
- To evaluate the effectiveness of implemented quality assurance strategies in reducing these errors.
- To assess the impact of clinical pharmacologist interventions and electronic alerts on methotrexate prescribing safety.
Main Methods:
- Retrospective analysis of non-oncological, low-dose methotrexate prescriptions for inpatients over 55 months.
- Clinical pharmacologists reviewed new methotrexate prescriptions for interventions at the physician level.
- An interruptive alert system at the point of order entry was evaluated in a secondary care setting.
Main Results:
- The incidence of too frequent prescriptions was 1.6% at the tertiary hospital (5 errors, 9 near misses).
- Pharmacologist interventions intercepted 2 prescription errors within 8 months.
- In the secondary hospital, the incidence decreased from 2.5% to 0.8% after implementing an electronic alert.
Conclusions:
- The observed rates of erroneous, too frequent low-dose methotrexate prescriptions are unacceptably high, posing risks of increased morbidity, mortality, and costs.
- Implemented quality assurance measures, including pharmacologist oversight and electronic alerts, demonstrated a positive impact on patient safety.
- Continuous monitoring and quality improvement initiatives are essential for safe methotrexate prescribing.
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