Hospital-prescribed drugs

Cytokine-modulating drugs should be initiated and prescribed under specialist supervision, so prescribing GPs may be unaware that patients are taking these drugs. A strategy is required to case-find patients who are prescribed these drugs in specialist care to avoid harm from medication interactions and also to raise awareness of possible immunosuppression, the increased risk of rapid spread of infection and to avoid administration of live vaccines.

The National Institute for Health and Care Excellence (NICE) has a compilation of advice, information and guidance relating to cytokine-modulating drugs on its website.

Audit criteria

All patients prescribed medication by a hospital or specialist team should have this medication documented on their GP medication list as well as the indication and information on the prescribing team in their GP records.

Search strategy

1. Search for patients coded as: rheumatoid arthritis (N040), ankylosing spondylitis (N100), psoriatic arthritis (M160), juvenile idiopathic arthritis, systemic lupus erythematosus (N000z).

2. Review current medication list on these patients to see if they are documented to be prescribed cytokine-modulating drugs (BNF section 10.1.3: cytokine modulators).

3. Review recent letters from their rheumatology teams to confirm which medication they are taking.

4. Add any hospital-prescribed medication to the patient's current medication list. Consider ways to do this that will prevent accidental issuing/dispensing of medications e.g. 'Hospital prescription for information only. Do not issue, do not dispense. Quantity 1' .

5. Consider adding Read code 66P (high-risk drug monitoring) as an active problem in patients' notes.