Hall William
Holland Park Surgery, London.
BMJ Qual Improv Rep. 2016 May 5;5(1). doi: 10.1136/bmjquality.u209711.w4039. eCollection 2016.
Domperidone is a dopamine D2 receptor antagonist acting on the chemoreceptor trigger zone in the medulla and also in the gut, causing antiemetic and gastrokinetic effects respectively. In the past, domperidone was considered largely safe, with many indications and few contraindications listed in the product literature. In 2014, Domperidone became indicated only for the prevention of nausea and vomiting and the duration of treatment was limited to seven days. Furthermore, the maximum daily dose was limited to thirty milligrams. A quality improvement project was undertaken at Holland Park Surgery to improve compliance with MHRA guidelines. Prescriptions of domperidone in the previous nine months were assessed for compliance with the MHRA advice. Domperidone was prescribed for 23 patients; of these 4 were single acute prescriptions, 3 were repeats which had been stopped and 16 were on active repeat at the time of the search. All patients who had active repeat prescriptions had exceeded the recommended duration of treatment. MHRA contraindications were found in 6 (37%) of active repeat prescriptions. The strategy for improvement involved three PDSA cycles and involved engaging with patients for medication reviews and staff to improve prescribing practices. After the third PDSA cycle we demonstrated that all repeat prescriptions had been stopped and that new prescriptions were compliant with MHRA advice.
多潘立酮是一种多巴胺D2受体拮抗剂，作用于延髓的化学感受器触发区以及肠道，分别产生止吐和促胃肠动力作用。过去，多潘立酮被认为基本安全，产品说明书中列出的适应证众多，禁忌证较少。2014年，多潘立酮仅被用于预防恶心和呕吐，治疗时长限制为7天。此外，最大日剂量限制为30毫克。荷兰公园外科开展了一项质量改进项目，以提高对药品和保健品管理局（MHRA）指南的依从性。对前九个月的多潘立酮处方进行评估，以确定其是否符合MHRA的建议。为23名患者开具了多潘立酮；其中4例为单次急性处方，3例为已停用的重复处方，16例在检索时为正在使用的重复处方。所有正在使用重复处方的患者均超过了推荐的治疗时长。在16例正在使用的重复处方中，发现有6例（37%）存在MHRA禁忌证。改进策略包括三个计划-执行-检查-处理（PDSA）循环，涉及与患者进行用药评估以及与工作人员合作以改善处方行为。在第三个PDSA循环之后，我们证明所有重复处方均已停用，并且新处方符合MHRA的建议。
