P018 Are hospital-only specialist drugs being flagged in primary care records - a step closer toward patient safety
Authors: Rajagopala Lavanya , Jain Aashna , Chowdhury Sumak Z , Gamage Dulan A. E , Ali Yasir A. A , Griffiths Bridget 
Published: April 2022

Abstract

Background/Aims
Rheumatologists prescribe many hospital-only medications (also known as red category prescriptions) including biologicals, chemotherapy such as cyclophosphamide, subcutaneous methotrexate and bosentan. The use of these medicines should be clearly communicated to primary care who should record this information in the patient’s electronic record to reduce the risk of a primary care clinician prescribing an incompatible medication and thus avoiding any potentially severe adverse events. It is also important to provide a complete list of medication when a patient is admitted to hospital acutely or referred to another department. Reflecting on a recent fatal incident, where a patient receiving subcutaneous methotrexate was prescribed trimethoprim by her GP and developed neutropaenic sepsis, our team was prompted to assess whether hospital-only prescriptions in our rheumatology cohort of patients are being flagged as a red drug in the GP system. Our objective was to determine if non-GP prescribed red drugs/hospital-only prescribed medications are being recorded in the patient’s primary care medication record.

Methods
We randomly selected 100 patients who attended the rheumatology day case unit from March 2021 to June 2021. We checked the newly available regional electronic patient record which contains information on medications listed on the primary care record, to see if the red drug was recorded in this record. We also recorded a patient’s age, gender, rheumatological diagnosis and the name of the hospital-only medication.

Results
Alarmingly, 50% of hospital-only medications were unflagged in the GP record system raising concerns about patient safety. 75% of the patients evaluated were female and their mean age was 56 (standard deviation 16.3). 61% were diagnosed with an inflammatory arthritis, of which rheumatoid arthritis was the commonest. Patients with CTD and vasculitis accounted for 39% of the population. 11% were receiving chemotherapy, 92% biologics and 12% subcutaneous methotrexate. A biological therapy was missed out more frequently compared with other categories.

Conclusion
A very high number of GP records did not have the hospital-only/red flag drugs recorded. This is a potential significant risk. The risk needs to be reduced by better communication between secondary care and primary care. Secondary care clinicians working in our trust can now check that the hospital only medication is correctly recorded on the GP prescribing system. If it is not recorded, then it needs to be highlighted to the GP practice in discharge letters and clinic letters. We hypothesise that this incomplete recording is not unique to our trust but a wider problem which needs to be addressed urgently to avoid preventable deaths. We propose that organisations ensure information about medicines prescribed elsewhere is reviewed on the GP clinical system at least annually, even if there are no changes to the medication. We as clinicians need to put patient safety first as an integral part of professionalism.

Disclosure
L. Rajagopala: None. A. Jain: None. S.Z. Chowdhury: None. D.A.E. Gamage: None. Y.A.A. Ali: None. B. Griffiths: None.