Aim To improve the overall process for the prescribing of biologics within the paediatric rheumatology service. The VBC would help achieve the following:
Successful implementation within the service.
Streamlined process for cost effective prescribing of biologics in line with national guidance.
Ensuring all patients receive the appropriate pre–biologic checks and documentation of core set criteria (where possible) to ensure safe prescribing.
Ascertaining other funding mechanisms for patients who do not meet national guidance or commissioning criteria.
Methods The VBC was modelled on the adult service and the process comprises of the following:
Patients starting or switching biologic therapy are highlighted in clinic.
Patients who require continuation in therapy are highlighted by the pharmacy homecare team.
For new patients, pre–biologic checks are ordered and routine bloods are requested for those continuing therapy.
VBC comprises of a 2 hour multidisciplinary team (MDT) meeting between a consultant paediatric rheumatologist or senior fellow, specialist nurse and pharmacist.
Patients referred to VBC are reviewed against our biologics clerking sheet. Ensuring pre–biologic checks have been completed, routine bloods have been checked, core set criteria has been recorded, patient is compliant with national guidance and that the appropriate Blueteq form has been completed.
A homecare registration (if required) and prescription form are completed.
A telephone consultation with the parent/patients is provided by the pharmacist explaining the homecare process and answering any clinical questions.
The specialist nurse completes output documentation for GP and arranges next follow up.
A real–time biologics database records core quality data for auditing purposes.
VBC list is sent to the service manager for reimbursement.
Patients who do not meet national guidance are referred to the weekly MDT.
Results The service has 120 patients being treated on biologics. Since November 2018, 112 patients of these patients have been reviewed. 1.7% have been non-compliant with national guidance and 5% did not have Blueteq numbers.
The VBC has enabled the MDT to assess response to biologic therapies by ensuring core set criteria is being recorded. A snapshot audit showed that documentation had increased from 25% to 50%.
Prescription turnaround time has reduced from 7 days to 3 days preventing treatment delay.
Discussion VBC has enabled the majority of patients to be reviewed, whilst showing we are compliant with national guidance. Routine and pre-biologic bloods had been requested for all patients and the recording of core set criteria had shown some improvement. Although not achieving the required level of documentation. Telephone consults have been perceived well by patients/parents. Having a pharmacist prescriber has had a positive outcome within the MDT and both the workflow and workload has improved.
Conclusion The VBC has been pivotal in improving patient care within the service. The MDT have collaboratively been able to ensure cost-effective prescribing, improve data collection, and reduce treatment delay whilst enhancing the pharmacist’s role. The process has highlighted the documentation of core set criteria is still low and requires further improvement. Ensuring compliance with NHS England commissioning criteria, Blueteq forms should be completed prior to prescriptions being written.
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