Improving hepatitis B screening prior to rituximab at a multispecialty urban hospital.

Authors

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Lakshminarayanan Nandagopal

University of Alabama at Birmingham, Birmingham, AL

Lakshminarayanan Nandagopal, Ravi Kumar Paluri, Barbara Gleaton, Diego Alonso De Idiaquez, Lisle Nabell

Organizations

University of Alabama at Birmingham, Birmingham, AL, Birmingham VA Medical Center, Birmingham, AL

Research Funding

Other

Background: Rituximab(R) is a novel anti-CD20 monoclonal antibody used in multiple hematologic and rheumatologic diseases. Patients who are hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) positive are at risk for hepatitis-B reactivation with R-based treatments. Therefore, the VA’s medication use evaluation tracker recommends serological testing for HBsAg, HBsAb and HBcAb within 6 months prior to initiating R. We conducted a PDSA cycle to improve Hepatitis-B serological testing in patients receiving R at Birmingham VA medical center (BVAMC). Methods: For baseline evaluation, patients at BVAMC who were treated with R between 2004- march 2014 were retrospectively evaluated for HBV serology results 6 months prior to first treatment. Presence of all 4- HBsAg, HBsAb and HBcAb (IgM and total) was complete; absence of all 4 was ‘not done’ with remaining being incomplete. After conducting a RCA, 3 pharmacy-based interventions were implemented- 1) pharmacy education; 2) pharmacist autonomy to order hepatitis B serology eliminating physician dependence; 3) pharmacy reminders to health care providers to order HBV serology. We aimed to improve ‘complete’ screening rates to > 90% in the post-intervention period (april 2014-sep 2016). Results: In the pre-intervention group (n = 162), majority (81%) had hematologic indications and complete testing was performed in 38%, reminder being incomplete (13%) or not done (49%). Post-intervention (n = 86), majority (54%) had rheumatologic indications with complete testing in 71%, incomplete in 15% and not done in 14%. No Hepatitis B reactivations were identified in either study periods. Conclusions: Pre-intervention, ‘complete’ testing was performed in only one-third of patients and our intervention was effective in almost doubling screening rates. We also demonstrate increasing use of Rituximab in non-hematologic conditions and with second-generation anti-CD20 Ofatumumab and Obinutuzumab also requiring similar testing; our study could standardize Hep-B screening for these agents. A second PDSA cycle with a reflex ‘forcing-function’ EMR-based tool to decrease reliance on human factors is planned to meet the study goal of > 90%.

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Abstract Details

Meeting

2017 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B: Patient Safety and Science of Quality

Track

Patient Safety,Science of Quality

Sub Track

Quality Improvement

Citation

J Clin Oncol 35, 2017 (suppl 8S; abstract 176)

DOI

10.1200/JCO.2017.35.8_suppl.176

Abstract #

176

Poster Bd #

C5

Abstract Disclosures

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