Shared Care – DMARDs

Practice Leads

  • Doctors: Sudhir Krishnan
  • Nurse: Jo Young
  • Admin: Chris Rushton

Date Reviewed

6th July 2016

Date of Next Review

September 2017

What to do when you get a new letter for shared care (pharmacist)

  • Please ensure you are using the correct template: “Ashcroft Shared Care”
  • Add read code “Management plan for shared care” (XaaTK)
  • Add a ‘Patient Plan’:‘patient on shared care drug (medication name), see shared care letter dated xx/xx/xx’
  • Add recalls:
    • Shared Care recall:“3 monthly bloods” (see DMARD template for exact monitoring requirements)
    • Rheumatoid arthritis recall (for QOF) – if patient has Rheumatoid arthritis, add yearly recall for review.
  • Add Shared Care medication to repeat – with a script note “3 monthly bloods” (see template for exact monitoring requirements)
  • If they are on methotrexate, add trimethoprim as a sensitivity(so that trimethoprim is never accidentally given)
  • Task ‘results’ team: ‘make 10 min appointment with Sadia within 4 weeks and add detail ‘DMARDs review’ on appointment please’.

What to do at the first review (pharmacist)

  1. Discuss what blood monitoring will take place (see shared care protocol).
  2. Explain to patient why blood monitoring is important– particularly if neutrophils or WCC goes down how serious that can be if they get any minor infections.
  3. Go through their blood schedulewith them
  4. Look at the shared care protocol (above) – check to make sure patient has no clinical signs of toxicity– and education the patient to report these if they occur.
  5. Give patient leaflet on DMARDs (see under Downloads & Link above))
  6. If patient has Rheumatoid arthritis, please add appropriate QOF read code Rheumatoid arthritis annual review (XaZdB)
  7. Ensure the patient completes the patient experience questionnaire

Rheumatoid arthritis annual review (GP or pharmacist)

  1. Check medication concordance
  2. Review bloods done (especially WCC, neutrophils and platelets)
  3. Assess cardiovascular risk (QRISK2)
  4. Recheck understanding (give information leaflet if not received)
  5. Ask about joints/swelling
  6. Ensure the patient completes the patient experience questionnaire

Shared care nurses appointment

  • Please ensure you utilise the “Ashcroft Shared Care” template
  • Add read code “high risk shared care monitoring” (XaL2z)
  • Take the necessary bloods and any other measurements (see SystmOne template or use monitoring manual under Downloads & Links section above).
  • Re-set the 3-monthly shared care recall schedule as per shared care protocol