By Dr Tim Soane, Neurology Registrar, Edinburgh
MS Specialists MasterClass 6, 2019
This quality improvement project began by auditing compliance with the local Natalizumab protocol, and then went on to revise the protocol. The audit identified good adherence to the pre-dosing infection requirements, and identified that over a twelve-month period, for all 28 patients this screening exercise did not affect management. Discussion with other MS centres in Scotland let to the decision to remove the requirement for routine bloods and urinalysis before every infusion. This reduces the requirements for patients to travel monthly, distances up to 3 hours, for these investigations, as well as increasing MS nurses time for other activities. The audit also identified good compliance with national guidelines on JCV and MRI monitoring.
The second part of the project involved providing pharmacy with a DMT prescribing algorithm, in order for them to better understand our prescribing decisions. Scotland does not use the Blueteq system, and the SMC guidance is slightly different to NICE guidance, meaning that existing algorithms from NHS England do not necessarily reflect Scotland’s position. The new algorithm will enable better pharmacy understanding of prescribing patterns and enable them to perform more informed cost analyses.