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N010. Review of a nurse led immunosuppressant service at a tertiary referral centre

T. Tyrrell

St. Mark's Hospital, Middlesex, United Kingdom

Aim: The nurse led immunosuppressant service was set up in 2007 to provide scheduled monitoring and review of appropriate blood tests for patients taking immunosuppressant medications. This service is carried out by the IBD specialist nurses via the telephone. This service was developed in response to a need for safe monitoring of patients in the event of their family doctor refusing to monitor, citing reason such as costs involved and unlicensed use of these medications.

This review of the nurse led immunosuppressant service provided information on the appropriateness of referrals to the service and duplication of work carried out by the patients' family doctor. This review also highlighted the actual increase in activity of this service since its development.

Materials and Methods: The service review was carried out retrospectively over a 9 month period from July 2009 to March 2010. Patient demographical information and medication history was recorded. A type of referral (local or tertiary) was recorded to investigate the presences of a trend.

Results: A total of 156 patients were monitored in the clinic over the 9 month period. This highlighted a 64% increase in referrals since this service was established. Of the 156 patients, 75% (n = 117) were taking Azathioprine, 17% (n = 28) taking Mercaptopurine, 5% (n = 9) on Methotrexate and a further 3% on medications including Adalimumab, Ciclosporin and 5-ASA. 59% (93) were male. 75% (117) of patients were from within the local area.

Duplication of monitoring was identified in 21% (n = 34) patients having blood monitored by both hospital and the family doctor.

Conclusion: The review highlighted the lack of GP support in performing blood monitoring in this group of patients (156).

This review of service has enabled for the specialist nurses to be more confident in discharging patient back to their family doctor for ongoing monitoring in 21% of cases. Given this number were discharged, there was still a significant overall increase in the workload for the specialist nurse with an increase in activity of 43% when taking the above figure into account.