The treatment of several diseases, particularly in rheumatology, gastroenterology, dermatology and cardiology, is increasingly reliant on drugs that, while clinically effective, need regular blood monitoring. This is due to the potentially serious side-effects these drugs can occasionally cause. It has been shown that the incidence of side-effects can be reduced significantly if this monitoring is carried out in a well-organised way.
Some areas commission monitoring as an enhanced service but it is also a good idea from a risk management perspective to set up a system to ensure that any patients on repeat medications for drugs such as methotrexate and azathioprine are regularly followed up.
This article is a practical guide on how to set up such a recall system. A quick disclaimer, I am not a clinician so please check with your clinical team on which drugs and which regularity they should be followed up. This article specifically relates to SystmOne as that is the clinical system my practice uses, however it will be possible to set up similar searches in other clinical systems.
Initial conversation with the patient
Each patient will need to have an initial conversation with a clinician when they are discharged to primary care on one of these drugs. The clinicians should explain the need for regular blood monitoring and how it will work in your practice.
patient.info also has patient information leaflets on all of these drugs so you can print a patient leaflet to go with the letter if you wish.
Setting up searches
My practice subscribes to Ardens, which provides a suite of templates, searches and standard letters for use with the SystmOne clinical system. Ardens has very kindly allowed me to use some of their searches in the attached templates. This is an example of Ardens' methotrexate monitoring template.
After the patient has had their initial meeting with the clinical team you will need to set up the following searches:
- Patients who are on a repeat prescription for each of the drugs you wish to monitor, one for each drug – click here for how to do this in SystmOne
- Patients who have had blood tests in the required time frame e.g patients who have had a full blood count in previous month – click here for how to do this in SystmOne
- When you have these searches you can join them so that you can see which patients are missing a particular blood test, for example patients on a repeat prescription for azathioprine but who haven’t had a FBC in the previous month – click here for how to do this in SystmOne
After these searches have been set up in your system, an administrator can run them each month to see which patients are due a blood test and invite the patients to have these blood tests following your usual protocol.
The patient’s specialist and the MHRA should be notified if there are any significant events associated with the monitoring of these drugs.
- Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member