Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis
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 ma...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
2015-11-01
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| Series: | Swiss Medical Weekly |
| Subjects: | |
| Online Access: | https://www.smw.ch/index.php/smw/article/view/2107 |
| _version_ | 1811288491908136960 |
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| author | Sascha Karlen Marc Oertle Stefan Weiler Markus Schneemann Emmanuel Eschmann Gerd-Achim Kullak-Ublick Juerg Blaser |
| author_facet | Sascha Karlen Marc Oertle Stefan Weiler Markus Schneemann Emmanuel Eschmann Gerd-Achim Kullak-Ublick Juerg Blaser |
| author_sort | Sascha Karlen |
| collection | DOAJ |
| description |
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.
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| first_indexed | 2024-04-13T03:38:01Z |
| format | Article |
| id | doaj.art-51f32b4c654c4e68b7c27d5be286ca0e |
| institution | Directory Open Access Journal |
| issn | 1424-3997 |
| language | English |
| last_indexed | 2024-04-13T03:38:01Z |
| publishDate | 2015-11-01 |
| publisher | SMW supporting association (Trägerverein Swiss Medical Weekly SMW) |
| record_format | Article |
| series | Swiss Medical Weekly |
| spelling | doaj.art-51f32b4c654c4e68b7c27d5be286ca0e2022-12-22T03:04:16ZengSMW supporting association (Trägerverein Swiss Medical Weekly SMW)Swiss Medical Weekly1424-39972015-11-01145474810.4414/smw.2015.14218Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysisSascha KarlenMarc OertleStefan WeilerMarkus SchneemannEmmanuel EschmannGerd-Achim Kullak-UblickJuerg Blaser 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. https://www.smw.ch/index.php/smw/article/view/2107quality controlpatient safetydrug safetymethotrexateOverdosemedication errors |
| spellingShingle | Sascha Karlen Marc Oertle Stefan Weiler Markus Schneemann Emmanuel Eschmann Gerd-Achim Kullak-Ublick Juerg Blaser Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis Swiss Medical Weekly quality control patient safety drug safety methotrexate Overdose medication errors |
| title | Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis |
| title_full | Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis |
| title_fullStr | Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis |
| title_full_unstemmed | Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis |
| title_short | Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis |
| title_sort | too frequent low dose methotrexate prescriptions multicentre quality control and quality assurance with pre and post analysis |
| topic | quality control patient safety drug safety methotrexate Overdose medication errors |
| url | https://www.smw.ch/index.php/smw/article/view/2107 |
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