In a local serious incident, a patient taking hydroxychloroquine lost their eyesight due to hydroxychloroquine induced retinopathy.
The investigation into the event highlighted that the patient had not been receiving the recommended ophthalmological monitoring.
We carried out a review of all primary care patients prescribed hydroxychloroquine in our locality, the aims of which were to ensure:
• All patients were receiving the recommended ophthalmological monitoring according to their individual risk profile
• Any patients prescribed over 5mg/kg/day (ABW) were known to secondary care as being high risk
• Any patients prescribed over the maximum dose of 6.5mg/kg/day (ABW) had their dose reviewed by their specialist as a priority. In total, 449 patients were reviewed by the ICB medicines optimisation team.
The key findings and outcomes were:
• 10 patients were not receiving the correct ophthalmological monitoring and were referred to ophthalmology
• 55 patients were prescribed doses >5mg/kg/day and were made known to secondary care
• 30 patients were prescribed doses >6.5mg/kg/day and had their doses reviewed by specialist
• 408 patients were identified as being under the care of rheumatology. Rheumatology did not have a full list of their hydroxychloroquine patients and therefore were able to create a database using our data, allowing them to better keep track of the monitoring going forwards
Knowledge gaps identified and fed back to relevant sectors:
• Some secondary care clinicians not aware that the presence of risk factor/s requires screening to begin after 1 year of treatment o some secondary care clinicians mistakenly under the impression that diabetic patients would have hydroxychloroquine issues picked up during diabetic screening therefore incorrectly not referring such patients for a specific hydroxychloroquine screen.
• A lack of awareness in primary care around the key counselling point that all patients, regardless of risk, should be seeing an optician for a routine check at least annually.
This work is now being carried out across other localities in Nottingham and Nottinghamshire and has highlighted similar issues as well as commissioning needs.
