Methotrexate in Psoriasis Shared Care Guidelines

1. E.Y. Cheung Medicines Management Team Camden CCG 19th May 2016 Methotrexate in PsoriasisShared Care Guidelines

2. NationalPatient Safety Agency (NPSA) Alert Working with the people of Camden to achieve the best health for all Oral methotrexate associated with high rate of adverse incidents and deaths Due to prescribing, dispensing, administering or monitoring errors Recommended actions: • Patient information & hand-held booklet • Shared Care Guidelines • Avoid ‘as directed’ – state dose • Separate repeat Px for review before signing

3. Principles of Shared Care Working with the people of Camden to achieve the best health for all Defines the individual responsibilities of the consultant/specialist team, GP and patient Information to enable GP to take on the legal and clinical responsibility of prescribing Communication between specialist, GP and patient GPs are invited to participate. Patient – explanation, consultation and agreement

4. Content of Shared Care Guidelines Criteria – psoriasis patient is initiated in secondary care and stablised on methotrexate, baseline assessments and monitoring after initiation Roles and responsibilities of specialist, GP and patient [who prescribes, who monitors, frequency of blood tests and in which location, who is responsible for receipt and review of results, who will communication dose changes to patients and GP, who will record test results in the patient-held monitoring booklet, attending appts] Clinical information ie indication, dose, administration, cautions, adverse effects, monitoring requirements, drug interactions, use in pregnancy and lactation. What action to take in the event of abnormal results. Contact details for specialist team NCL wide MTX SCG currently being developed and updated

5. Medicines Management Webpage Working with the people of Camden to achieve the best health for all

6. Medicines Management Webpage Working with the people of Camden to achieve the best health for all Via GP Website

7. Key Points Working with the people of Camden to achieve the best health for all Patient education/counselling and patient-held monitoring booklet Ensure you clear on the responsibilities and are happy to these on Prescribe 2.5mg tablets only (not 10mg tablets) Weekly dosing frequency Avoid the use of ‘as directed’ – state the dose Recall and call system (patients missing monitoring appts) Camden CCG Locally Commissioned Service (LCS) for prescribing and monitoring methotrexate

8. Working with the people of Camden to achieve the best health for all Thank you and any questions? Mmt.camdenccg@nhs.net