National Medicines Safety Improvement Programme Team, NHS England, London, UK
National Medicines Safety Improvement Programme Team, NHS England, London, UK.
BMJ Open Qual. 2022 Aug;11(3). doi: 10.1136/bmjoq-2022-001942.
Harmful or fatal errors related to accidental overdose of methotrexate tablets are well documented. In England, the coprescription of 2.5 mg and 10 mg methotrexate tablets is not recommended, because both tablets look similar, and may be confused with each other, leading to a potential overdose of methotrexate. It is recommended that one tablet strength (usually 2.5 mg) is prescribed and dispensed. A recent retrospective cohort study identified that while 97% of patients in England were prescribed only 2.5 mg methotrexate tablets, the prescribing of 10 mg tablets or combinations of 2.5 mg and 10 mg tablets was still common practice in a small number of geographical areas across the country.
To reduce national variation in the prescription of oral methotrexate 10 mg tablets, for non-cancer treatment, by November 2021. A focused, five-stage quality improvement (QI) intervention was used, providing centralised support to a cohort of high prescribing integrated care systems (ICSs) in England.
23% (10) of ICSs in England were responsible for 76% of prescribing of methotrexate 10 mg tablets. Eight of these high prescribing ICSs participated in the QI intervention between March and November 2021. During the action period, the high prescribing cohort saw a 54% reduction in the prescribing of methotrexate 10 mg tablets, with seven ICSs seeing reductions of between 41% and 75%, resulting in reduced variation between the high prescribing ICSs and all other ICSs. The intervention was well received by ICSs with all making structural changes to their respective systems so that improvement would be sustained.
The success of this project raises several exciting opportunities for further work of this nature, particularly where this is significant variation in practice across the country.
与甲氨蝶呤片意外过量相关的有害或致命错误已有充分记录。在英国，不建议同时开 2.5mg 和 10mg 甲氨蝶呤片，因为这两种片剂看起来相似，可能会相互混淆，导致甲氨蝶呤潜在过量。建议开一种片剂强度（通常为 2.5mg）。最近的一项回顾性队列研究表明，虽然英格兰 97%的患者只开了 2.5mg 甲氨蝶呤片，但在全国少数几个地理区域，仍有开 10mg 片剂或 2.5mg 和 10mg 片剂组合的情况。
到 2021 年 11 月，减少全国范围内非癌症治疗时开口服甲氨蝶呤 10mg 片剂的差异。采用集中支持英格兰高处方综合保健系统（ICS）队列的集中、五阶段质量改进（QI）干预。
英格兰 23%（10）的 ICS 负责开出了 76%的甲氨蝶呤 10mg 片剂。其中 8 个高处方 ICS 参加了 2021 年 3 月至 11 月的 QI 干预。在行动期间，高处方队列中甲氨蝶呤 10mg 片剂的处方量减少了 54%，其中 7 个 ICS 的处方量减少了 41%至 75%，从而减少了高处方 ICS 与所有其他 ICS 之间的差异。ICS 对干预反应良好，所有 ICS 都对其各自的系统进行了结构性改变，以便持续改进。
该项目的成功为进一步开展此类工作带来了一些令人兴奋的机会，特别是在全国范围内存在显著实践差异的情况下。
