Clinical audit suggestions: disease-modifying anti-rheumatic drugs (DMARDs)

Standards

The British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) guidelines for disease-modifying anti-rheumatic drug (DMARD) therapy, in consultation with the British Association of Dermatologists 

British National Formulary section 10.1.3 Drugs that suppress the rheumatic disease process

National Institute for Health and Care Excellence (NICE) clinical knowledge summary for DMARDs

Assessing, managing and monitoring biologic therapies for inflammatory arthritis: guidance for rheumatology practitioners (PDF, 557 kb) from the Royal College of Nursing

Audit criteria

All patients on DMARDs (whether hospital- or GP-prescribed) should have the drug documented on their current medication to alert prescribers to possible drug interactions.

All patients on DMARDs should have ‘high-risk drug monitoring’ coded as an active problem in their medical records.

All patients on DMARDs should be managed according to local shared care guidelines (if medication prescribed in primary care) and be in possession of a disease-monitoring book.

All patients on DMARDs should have regular blood monitoring which conforms with BSR/BHPR guidance.

All patients on DMARDs should be offered pneumonia and seasonal influenza vaccination.

Patients on DMARDs should be signposted to information and this should be documented in their notes.

Resources

Read code: 66P high-risk drug monitoring

Read code: 65E (influenza) and 6572 (pneumococcal) vaccinations