RT Journal Article SR Electronic T1 National quality improvement intervention to reduce high risk oral methotrexate prescribing JF BMJ Open Quality JO BMJ Open Qual FD British Medical Journal Publishing Group SP e001942 DO 10.1136/bmjoq-2022-001942 VO 11 IS 3 A1 Innes, James A1 Jamieson, Tony A1 Dales, Ruth A1 Lloyd, Robert YR 2022 UL http://bmjopenquality.bmj.com/content/11/3/e001942.abstract AB Background Harmful or fatal errors related to accidental overdose of methotrexate tablets are well documented. In England, the coprescription of 2.5 mg and 10 mg methotrexate tablets is not recommended, because both tablets look similar, and may be confused with each other, leading to a potential overdose of methotrexate. It is recommended that one tablet strength (usually 2.5 mg) is prescribed and dispensed. A recent retrospective cohort study identified that while 97% of patients in England were prescribed only 2.5 mg methotrexate tablets, the prescribing of 10 mg tablets or combinations of 2.5 mg and 10 mg tablets was still common practice in a small number of geographical areas across the country.Aim and methodology To reduce national variation in the prescription of oral methotrexate 10 mg tablets, for non-cancer treatment, by November 2021. A focused, five-stage quality improvement (QI) intervention was used, providing centralised support to a cohort of high prescribing integrated care systems (ICSs) in England.Findings 23% (10) of ICSs in England were responsible for 76% of prescribing of methotrexate 10 mg tablets. Eight of these high prescribing ICSs participated in the QI intervention between March and November 2021. During the action period, the high prescribing cohort saw a 54% reduction in the prescribing of methotrexate 10 mg tablets, with seven ICSs seeing reductions of between 41% and 75%, resulting in reduced variation between the high prescribing ICSs and all other ICSs. The intervention was well received by ICSs with all making structural changes to their respective systems so that improvement would be sustained.Conclusions The success of this project raises several exciting opportunities for further work of this nature, particularly where this is significant variation in practice across the country.All data relevant to the study are included in the article or uploaded as supplementary information.