High dose methadone prescribing and medical review: a completed audit cycle (Midlothian 2012-14)

First published: 10/05/2019 | Last updated: May 20th, 2019

Abstract: High dose methadone prescribing and medical review: a completed audit cycle (Midlothian 2012-14). Petrie, RXA

Background

Methadone can result in QTc prolongation, and this effect is possibly dose-dependent. Moreover, patients on high dose methadone often have other QTc risk factors. This is one (of many) reason(s) why regular medical review of all patients on high dose methadone is important. Prescribing for this patient group should be such that the need for ECG monitoring is minimised.

Aims:  To establish a current practice baseline of medical review in high dose methadone patients (2012).  Following feedback of baseline data to keyworkers, recommendations were made. The dataset was then re-audited (2014) to establish whether this led to any quality improvement.

Method:

•             The following case note data for high dose methadone patients in Midlothian (defined as methadone ≥ 100mg/day) was collected at baseline (2012): methadone dose, other prescribed drugs (including GP prescriptions), co-morbid conditions, medical review/discussion within last 6 months?, ECG requested?, patient attended for ECG?, ECG result available/QTc prolonged?, prescription altered as a result of ECG (or other reason)?.

•             The results were fedback to keyworkers, and 6 monthly medical reviews were recommended.

•             The same data was collected for re-audit (2014).

Results: Compared to baseline (2012), the re-audit (2014) shows more frequent medical review/discussion, reduction in the number of high dose methadone prescriptions, and better recording of co-morbidity and other prescriptions. There were more ECG requests but no improvement in attendance. Few patients had QTc prolongation in either baseline or repeat audit. Prescriptions changes were more often made for other clinical reasons rather than as a direct result of ECG.

Conclusions:

Medical review/discussion with the opportunity for rationalising prescriptions and requesting ECG, is now more routine for high dose methadone patients in Midlothian. Changes in prescriptions are less commonly a result of QTc results per se, and are more often made for other clinical reasons.

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Dr Rachel Petrie