Monitoring people who are on disease modifying drugs (DMDs) is paramount to providing safe, high-quality MS care.
But it’s not always easy. The infrastructure isn’t widely in place and many services track patients using paper records or spreadsheets which can’t be accessed by everyone involved in a patient’s care.
As Ben Dorward, lead neurosciences pharmacist at Sheffield Teaching Hospitals NHS Foundation Trust, has shown, joined-up working, utilising technology and more than a little persistence can help.
His project, to jointly develop an IT system that links prescription management to blood monitoring and can be accessed by the MS and pharmacy teams, was shortlisted for the Quality in the Delivery of Services (QuDoS) in Multiple Sclerosis recognition programme.
Recognising the contribution of pharmacy
“It was very flattering to be nominated,” said Ben, adding that it was gratifying to see the contribution pharmacy teams make to the MS multidisciplinary team and patient care being recognised.
The IT system was designed to make sure everyone on a DMD in the Sheffield area has the right blood monitoring tests at the right time and, crucially, that drugs are only prescribed when it’s clinically appropriate.
By integrating the blood monitoring and prescription generation processes, hospital pharmacists can easily access the most up-to-date test results. This means they can ensure it’s safe to release prescriptions to the homecare companies to dispense.
The database also allows people to have their bloods done closer to home.
“The MS team had identified the challenges and risks of safely monitoring the existing and emerging DMDs,” said Ben, adding that DMD pathways, including homecare, had become ever more complex in the 16 years he had been a neurosciences pharmacist.
Separate systems with limited access
Describing a previous set of processes that many would be familiar with, Ben said: “The blood tests were being managed within a Microsoft Access database by the MS team, and prescriptions were managed by the pharmacy team within an Excel spreadsheet.”
“We had two separate systems, with limited functionality and access that did not talk to each other.”
This led to recurrent clinical incidents of missed blood tests and the inappropriate generation of prescriptions.
“With the support of our senior management team, the risk was escalated to a high level within our organisation and the funding was agreed for a system that was jointly developed with our NHS Trust’s clinical informatics team,” said Ben.
While it’s difficult to define the metrics around the impact of the database, the team have seen a reduction in DMD-related clinical incidents since the system was introduced.
“We are confident that we are more safely managing a large cohort of people with MS on DMDs, spread across a large geographical area, by ensuring we are undertaking and reviewing the necessary blood safety tests,” said Ben.
“Because the laboratory systems of the hospitals in our service area are linked up, the Sheffield MS Service can facilitate blood testing local to where patients live, minimising disruption and allowing people with MS to get on with their lives — which is ultimately what these treatments are trying to achieve.”
It wasn’t an overnight transformation, however, and developing the system was a long process of building, testing, refining and re-testing.
“It took more than seven years from entering the monitoring of DMDs onto our clinical risk register to the system going live, which happened in 2016.”
“It started with a phased introduction of the blood monitoring module, followed by the prescription management module several months later,” said Ben.
And there’s no room for complacency, as the team are always identifying elements of the system that could work better as technology moves on.
“Currently, it only generates letters, so we want to explore the use of different communication methods, based on patient preference. We are also exploring options for greater automation, such as the direct import of blood tests from hospital laboratory systems,” said Ben.
“I think we also need to be cognisant that electronic prescribing may come to homecare at some point and think about how we would manage that.”
Persistence and sharing best practice
Asked his advice to anyone looking at embarking on a similar project, Ben said support from senior management had been invaluable — and that gaining that support was reliant on persistence.
“My own biggest challenge was gaining acknowledgment that DMD prescriptions are inextricably linked to the safety monitoring and the two processes had to be managed in tandem,” he said.
“I’d also say map the processes clearly to identify all of the staff groups involved in the pathways and don’t forget to consider third parties, such as homecare companies.”
Learning from each other’s experience is also key, he added, advising teams to speak to fellow centres that have been through similar processes to find out what did and did not work for them.
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