title: Methotrexate: improving safety profile.
abstract: Over the past 10 years, there have been 137 patient safety incidents in England associated with methotrexate prescribing. Recent reports show that Australia has similar concerns. Using the valuable tool of an audit, we reviewed our departmental prescribing practices for 49 patients with psoriasis on methotrexate. Results highlighted poor documentation that patients were receiving appropriate information sheets detailing complications of the drug. Inconsistencies between prescribers were also noted, particularly in regards to haematological monitoring. A review of the current published work and the guidelines of other leading centres was performed and consistent, evidence-based guidelines were produced for the department. Such guidelines are essential in order to minimize the recognized complications of methotrexate. Recent studies highlight procollagen peptide III as a valuable adjunct for monitoring hepatotoxicity, while there is no longer a significant role for routine recording of cumulative dose. It would be valuable to repeat the audit to ensure a change in practice and an improved adherence to common guidelines.
authors.affiliation: Department Dermatology, Churchill Hospital, Oxford, UK. nandcgrills@optusnet.com.au
authors.forename: Claire
authors.initials: C
authors.lastname: Grills
authors.forename: Susan
authors.initials: S
authors.lastname: Burge
mesh_terms: D001774:Blood Chemical Analysis / Q000706:statistics & numerical data; D024061:Collagen Type III / Q000032:analysis; D003879:Dermatologic Agents / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D004573:Electrolytes / Q000032:analysis; D005492:Folic Acid / Q000627:therapeutic use; D006801:Humans; D008111:Liver Function Tests / Q000706:statistics & numerical data; D008727:Methotrexate / Q000627:therapeutic use*; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000188:drug therapy*; D006113:United Kingdom; D014508:Urea / Q000032:analysis
chemical_list: D024061:Collagen Type III; D003879:Dermatologic Agents; D004573:Electrolytes; D014508:Urea; D005492:Folic Acid; D008727:Methotrexate