LAUSR

Who is responsible for the blood monitoring of disease modifying anti-rheumatic drugs (DMARDs)? It may be Primary Care, Specialist Rheumatology teams or a combination. In Greater Manchester, it was deemed good practice to initiate ‘amber’ conventional synthetic DMARDs (cs-DMARDs) by Rheumatology and then transfer to Primary Care under shared care after 3 months or when blood monitoring was stable. ‘Red’ drug prescribing and monitoring for targeted synthetic DMARDs (ts-DMARDs) and biologics (b-DMARDs) would remain under Specialist care long-term. In 2013, the process began for the Rheumatology team at Bolton to take on the ‘in house’ initiation of cs-DMARDs and the implementation of formal shared care. It would not be possible to manage this with paper slips of pathology results and shared care booklets, as the workload and safety implications would be un-manageable for our small team. The Rheumatology department purchased blood monitoring software, allowing only abnormal results or concerning trends to filter through. The implementation of this new way of working required collaborative working with the Informatics, Laboratory, Software and Rheumatology teams, as well as Primary care. At the time, the likely numbers of patients monitored and the workload of abnormal results/trends was unknown. Here we share our experience of software-based rheumatology DMARD monitoring in a district general hospital setting, serving a population of nearly 300 000. Roles and responsibilities were allocated across the multidisciplinary, administration/clerical and informatics teams. A workflow and weekly timetable of activity and cross cover for leave was implemented. Two ‘super-users’ (AP/LB) undertook the initial testing of the software with informatics support (DE) and still work closely to address any data flow issues, software updates and testing related to emerging DMARDs. The patient cohort included those starting ‘amber’ DMARDs (to the point of shared care), stabilization following a dose increase and those remaining on specialist only ‘red’ DMARDs. Since 2019, a monthly monitoring report has allowed a more detailed documentation of workload. There were 518 patient licenses in use December 2019, 589 in 2020 and 635 in 2021. In the pre-pandemic year of 2019, 203 patients were newly registered or re-registered. Abnormal results and concerning trends were ‘flagged’ by the software for 719 patients. 263 shared care agreements were generated for monitored DMARDs. This workload data relates to the use of software-based DMARD monitoring in a Rheumatology department, where patient flows relate to 1 whole time equivalent Rheumatology Consultant per 100 000 population. Centres considering taking on a similar form of DMARD monitoring can extrapolate this data for their population and patient flow to guide regarding staffing needs. Disclosure A. Paul: None. L. Bromilow: None. D. Eckersley: None.