The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.
Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows
- Stop date for prescribing oral methotrexate
- Date of transfer of prescribing to primary care
- Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
- Any additional monitoring required and who will do this?
- Dose of methotrexate subcutaneous to be prescribed
Other responsibilities for specialist team.
- Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
- Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
- Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here Sharps and clinical waste disposal - Council arrangements - update
Patients should be provided with sharps bin on dispensing of 1st prescription
A new shared care document will not be required, as primary care have already accepted shared care.
The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications
The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.
This shared care protocol applies to adults aged 18 and over.
This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.
These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).
