Adherence to national recommendations for safe methotrexate dispensing in community pharmacies.
BACKGROUND
The number of patients using methotrexate (MTX) has increased during the last decade. Because of the narrow therapeutic range and potential risks of incorrect use, vigilance is required when dispensing MTX. In 2009, the Royal Dutch Pharmacists Society, in accordance with the Dutch Health Care Inspectorate, published safe MTX dispensing recommendations for community pharmacies.


OBJECTIVE
To examine adherence to recommendations aimed at safe  MTX dispensing.


METHODS
This study was conducted within a convenience sample of 78 community pharmacies belonging to the Utrecht Pharmacy Practice Network for Education and Research (UPPER). Data were collected in May 2011.


RESULTS
95 pharmacists and 337 pharmacy technicians were interviewed to assess self-reported adherence with dispensing recommendations. In addition, medication records for patients using MTX were extracted in 52 pharmacies in order to objectively assess adoption of recommendations. More than 75% of the pharmacists and pharmacy technicians reported to be adherent to 6 of the 11 recommendations. There are variations in reported adherence between team members working in 1 pharmacy; higher adherence rates ( greater than 75%) for the pharmacy team as a whole were only shown for 2 recommendations (recording of day of intake on the label and moment of authorization by the pharmacist). The medication records showed that adherence with working procedures significantly increased: The number of dispensed records with notification of the day of intake on the medication label increased from 9.9% of the records per pharmacy in 2008 to 77.1% in 2010 (P  less than  0.001).


CONCLUSIONS
Dutch community pharmacies seem to be adherent to most safe dispensing recommendations. However, inconsistencies exist between team members that emphasize the importance of addressing this issue and discussing recommendations within the team, as there is still room for improvement to ensure safe dispensing.
Utrecht University, Division of Pharmacoepidemiology Clinical Pharmacology, PO Box 80082, 3508 TB, Utrecht, The Netherlands. e.koster@uu.nl.
Ellen S
ES
Koster
Joelle C D
JC
Walgers
Mariska C J
MC
van Grinsven
Nina A
NA
Winters
Marcel L
ML
Bouvy
D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000592:standards; D003625:Data Collection; D004348:Drug Labeling; D019983:Guideline Adherence; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D009426:Netherlands; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D010596:Pharmacy Technicians / Q000458:organization & administration / Q000592:standards; D017410:Practice Guidelines as Topic
D018501:Antirheumatic Agents; D008727:Methotrexate