Improving the safety of prescriptions of domperidone in primary care: implementing MHRA advice.

Domperidone is a dopamine D2 receptor antagonist acting on the chemoreceptor trigger zone in the medulla and also in the gut, causing antiemetic and gastrokinetic effects respectively. In the past, domperidone was considered largely safe, with many indications and few contraindications listed in the product literature. In 2014, Domperidone became indicated only for the prevention of nausea and vomiting and the duration of treatment was limited to seven days. Furthermore, the maximum daily dose was limited to thirty milligrams. A quality improvement project was undertaken at Holland Park Surgery to improve compliance with MHRA guidelines. Prescriptions of domperidone in the previous nine months were assessed for compliance with the MHRA advice. Domperidone was prescribed for 23 patients; of these 4 were single acute prescriptions, 3 were repeats which had been stopped and 16 were on active repeat at the time of the search. All patients who had active repeat prescriptions had exceeded the recommended duration of treatment. MHRA contraindications were found in 6 (37%) of active repeat prescriptions. The strategy for improvement involved three PDSA cycles and involved engaging with patients for medication reviews and staff to improve prescribing practices. After the third PDSA cycle we demonstrated that all repeat prescriptions had been stopped and that new prescriptions were compliant with MHRA advice.