PTU-096 The use of a simple bespoke it tool significantly improves patient compliance with immunosuppressant monitoring

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Introduction Immunosuppressant monitoring is a vital function of the multidisciplinary IBD team. However, it remains a difficult process to undertake safely and effectively in an NHS setting, consequently often incurring a significant governance risk. To address this the IBD team developed a simple immunosuppressant monitoring tool (IMT). We report the initial results from this compared with a historical cohort. Methods Using a simple Excel algorithm we developed a database that automatically populated blood monitoring dates highlighting individual patient’s status using a traffic light system. Patients were followed up in secondary care for the first 12 weeks with stable patients then handed over to primary care using a shared-care protocol. All immunosuppressant prescriptions were initiated through a specific IBD nurse/pharmacist clinic and prospectively monitored with data recorded on the IMT. Results were compared to a retrospective cohort of patients monitored prior to the introduction of the IMT. Results 65 patients starting on immunosuppression were prospectively monitored using the IMT. These patients were compared with 30 historical controls. In the IMT group 335 blood tests were required for 100% compliance over the first 12 weeks of monitoring. 298/335 (88.9%) of blood tests were taken, compared with 123/175 (70%) of blood tests taken in the control group initiated prior to the IMT (p=0.01). 100% of the 335 requested bloods were logged in the IMT with actions recorded for the 37 missing tests (28 missed blood tests chased via phone, 3 discontinued treatment, 2 delayed starters and 4 pending that week). Comments on abnormal bloods or metabolites were logged in 186 (55.5%) of cases. This data was not routinely collected prior to implementation of the IMT. Compliance with monitoring at all time points was better in the IMT than control group (week 1 95.4% v 93.3%, week 2 95.1% v 75.9%, week 4 93% v 72.4%, week 6 85.7% v 72.4%, week 8 86.0% v 55.2%, week 1273.9 v 51.7%). Conclusions Implementation of a simple bespoke IT monitoring tool using a traffic light system significantly improves compliance with blood monitoring in patients initiating immunosuppressant treatment. The development of an IT trail dramatically improved documentation and clinical governance surrounding monitoring. Feedback has been universally positive with the new system markedly reducing the nursing burden associated with monitoring. The IBD team has identified areas where compliance can be improved, which are now being actively investigated. We are happy to make the software available to other teams on request.

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