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Background Medication prescribing in paediatric rheumatology is closely monitored, particularly as a large number of medications used are either DMARDs or biologic therapy. Within our centre, we aim to give prescriptions when patients are attending outpatient clinics however due to long waiting lists, some patients require prescriptions before their clinic appointment. Currently, this is arranged by parents phoning in to our secretaries, however they often do not have the medication dose or route and this can delay efficient prescribing. We have also found that as most patients have their blood monitoring done in a primary care setting, we do not have access to their results. The aim of our audit was to formally assess outpatient prescribing in our centre, with a view to streamlining the process. Methods Data was collected over a one month period between 05/03/19 and the 05/04/19. Each prescription request was received by our CNS or secretary and passed to the NCHDs. The date and medication required was documented, along with chart availability, last clinic date, last bloods taken, whether the parents gave the dose and if a prescription was ultimately written. All data was analysed using Microsoft Excel. Results In total 36 prescriptions were requested. The majority of prescriptions (28) were routine prescriptions, with an additional 6 for 'emergency' prescriptions (e.g. diclofenac, ondansetron, NSAIDs and prednisolone) and 2 prescriptions were for a change in medication. Overall, 17 requests were for biologic agents, 7 for methotrexate and 5 for both biologic and methotrexate. Charts were available for 27 patients. Of those not available, 5 parents had given doses with their requests. If doses and charts were not available the dose from the last clinic letter on the system was used. Only in 10 cases out of 36, did parents leave a dose for medication with their prescription request. In total, 21 patients had recent blood tests recorded on our hospital database in the last 3 months and 27 had had clinic appointments in the preceding 6 months, with 13 of these occurring in the preceding 3 months. Conclusion This study highlights the large volume of external prescription requests received, as well as the potential for error in prescribing. We are currently planning on introducing a form that parents will be required to complete with all prescription requests, detailing dose and route of medication along with the results of their most recent blood tests. We hope that this will both streamline the process and allow for safer prescribing and plan to re-audit 3 months after its implementation. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Tocilizumab (TCZ) is a monoclonal antibody that targets the interleukin 6 receptor. It is approved for use in children over the age of 2 years with systemic onset juvenile idiopathic arthritis (SoJIA) and polyarticular juvenile idiopathic arthritis (pJIA) who have not responded to treatment with non-steroidal agents, corticosteroids and methotrexate mono-therapy. Previous studies from our centre have shown a positive response to IV TCZ with high rates of remission. TCZ has recently been licensed for administration via the SC route. The aim of this study is to determine how many patients receiving IV TCZ were successfully changed to SC TCZ in the first 6 months after SC TCZ paediatric licensing was obtained and to document any adverse events. Methods Retrospective review of patients with SoJIA or pJIA who were on IV TCZ and changed to S/C TCZ over a 6 month period from October 2018 to April 2019. Patients were identified from an in-house aseptic pharmacy database Clinichemo®. All patients on IV TCZ were identified and cross checked against the Hibernian patient referral system for home SC TCZ administration. Criteria for changing included fulfilling Wallace Criteria for clinical remission and appropriate JIA subtype. Results were analysed using Microsoft Excel. Results 28 patients receiving IV TCZ in October 2018 were identified. 8 were excluded due to either a diagnosis other than SoJIA/pJIA or changing to an alternative biologic. Of the 20 eligible patients, 10 had successfully changed by April 2019. Of those who did not change, 1 is due to change in May 2019, 2 did not wish to change, indicating personal preference as their reason. A total of 7 were deemed unsuitable for medication change due to ongoing active disease. Of the 10 patients who successfully changed, 2 had SoJIA and 8 had pJIA. All were commenced on a dose of 162mg with frequency varying from 1 to 4 weekly as per Summary of Product Characteristics. There was no significant change in ESR, CRP, LFT or WCC demonstrated pre or post change in administration route. No adverse events were reported. 1 patient subsequently changed back to IV administration due to patient preference. Conclusion Our experience to date has been positive, with 50% of patients changed to SC administration within 6 months of approval. A number of other patients have been identified for a change to SC TCZ within the next 6 months. While 1 patient subsequently elected to change back to IV TCZ, to date, no patient has come off SC TCZ due to an increase in disease activity. We hope to follow this study with a patient questionnaire to determine the patient perspective of changing to SC administration of TCZ. Conflicts of Interest The authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]