Indication:Inflammatory Arthritis & Connective Tissue Disease for Adult Services, over 16
Management of Rheumatoid Arthritis in adults
Safe Prescribing checklist
o Information on the risks and benefits of oral methotrexate should be given to the patient.
o Confirmation of the patient’s understanding and consent should be sought, baseline tests conducted, monitoring schedule explained, and patient-held monitoring booklet issued.
o All prescribers must avoid the use of as directed in prescribing â a specific dose must be applied to each prescription. Bear in mind that patients often understand their dose by the number of tablets they take rather than mg. The required quantity and frequency of dose should be regularly discussed with the patient.
o Avoid prescribing the 10mg strength of methotrexate, use the 2.5mg strength tablets.
o Repeat prescriptions should be retained separately for prescriber review prior to authorising.
o Be aware of patients who attend with symptoms such as breathlessness, dry persistent cough, vomiting or diarrhoea, as these can be signs of oral methotrexate toxicity or intolerance.
o Handwritten prescriptions and discharge summary information must be complete, legible and include the form, strength, dose and directions in full.
Safe dispensing practice checklist
o Ask to see the patient’s monitoring booklet and check if any dose changes have been made since the last prescription issue.
o Assess the needs of the individual patient. For example, if the new packaging is not available, patients who have reduced manual dexterity should be given larger containers or ribbed easy-to-grip lids as this could reduce the likelihood of them decanting the tablets into another container at home (Disability Discrimination Act applies).
o The strength of tablet supplied to the patient must stay consistent to prevent any confusion about the number of tablets they need to take, and the patient’s monitoring document and Patient Medication Record should be checked to confirm the previous supply.
o Tell the patient their dose in terms of quantity of tablets and weekly frequency. Give the patient a monitoring booklet if they have not already got one.
o Show the patient how to differentiate between the oral methotrexate and folic acid packaging. If they take both medicines at the same time, they will need to know how to distinguish between them, given that both may be round yellow tablets of similar size.
o Be aware of patients who attend with symptoms such as breathlessness, dry persistent cough, vomiting or diarrhoea, as these can be signs of oral methotrexate toxicity or intolerance. You may need to refer them back to the prescriber. It is good practice to maintain a record of any over-the-counter items supplied to the patient.
NPSA Patient safety alert 13
Improving compliance with oral methotrexate guidelines 2006