By Beverley Bowers, MS Specialist Nurse, Royal United Hospital & Dr Pamela Sarkar, ST7 Neurology, North Bristol NHS Trust
MS Intermediate MasterClass 8, 2019
Our project was to explore the current state of DMT monitoring at a local DGH prescribing centre. Currently one MS nurse specialist is responsible for 172 RRMS patients on DMTs. There is no electronic database for DMT monitoring (in a recent MS Trust nurse survey, only 26% of prescribing centres in the U.K. have an electronic or IT system database). Care is planned on an individual patient basis during appointments using individual patient records.
We noted in our review that 37% of patients had blood monitoring tests overdue. 50% of patients on Tysabri were overdue on MRI monitoring. 70% of patients did not have EDSS scores recorded in their last clinic letter. Overall, several patients were not complying with national guidelines of DMT monitoring, therefore a change in practice was required urgently.
Working with Biogen, the DMT patient Blood Monitoring Tracker was installed and uploaded onto the Neurology shared drive for all Neurology staff to access and update. We recorded the entire DMT patient cohort onto the database, and manually searched to record last performed blood tests, prescription dates, MRI scans, JC titres and EDSS scores. We entered flagging criteria for all parameters. This system also allows tracking of DMT switching or stopping, monitoring progress of disability and prompts accurate recording of EDSS on clinical records. It can also be used in clinic as a reminder of when tests are due and encourage change of practice for the DMT service.
We reviewed our practice 4 months after installation of the database. EDSS scores are recorded significantly better (at 90%). 80% of patients on Tysabri have had their scans as per monitoring guidelines. 90% of patients are now compliant with blood monitoring.
Although administration time will need to be dedicated to maintain the database, we have shown substantial benefits to having a new electronic database in place including managing patient safety while on DMTs, eliminating missed monitoring for blood tests and MRI scans, more accurate review and audit of choice of DMT and whether the DMT is appropriate for the patient (such as with breakthrough relapses or worsening disability), ease of completion of Blueteq form and reducing MS nurse work load by using a more efficient monitoring system.