Background In the conventional practice of biologic infusion in Hong Kong, patients have to be seen by rheumatologist for every visit to get the prescription followed by drug purchase and administration. To streamline the workflow and to reduce doctor's workload on routine visits, a pilot project of nurse-led biologic infusion (NLBI) clinic has been launched.
Objectives (1) To evaluate the effectiveness and safety of the NLBI service; (2) to assess the reduction in patient waiting time from admission to discharge in day ward and (3) to quantify the reduction in workload of rheumatologists.
Methods Patients receiving biologic therapy with stable conditions were recruited to the NLBI clinic by rheumatologists. Alternating follow-up sessions by NLBI clinic and rheumatologist was arranged. Rheumatologists would assess the patient and prescribe the appropriate drug regime for the next NLBI clinic. During NLBI clinic visit, patient's clinical conditions, including their disease activity, laboratory results and vital signs were assessed according to standardized protocol to ensure treatment safety. After the infusion therapy, rheumatology nurse will make proper discharge record to ensure continuity of care. For patients with unstable conditions or infusion reactions, rheumatologists are readily available for timely management.
Results The NLBI clinic was set up in April 2012, totally 23 patients were recruited in the clinic and currently 21 patients (91.3% of total biologic infusion case) were still under the programme. Two patients dropped out due to switching to other biologics which are administrated by subcutaneous injection. Three episodes required ad hoc referral to rheumatologist for medical problems including hyperglycaemia, hypertension and skin rash. From April 2012 to December 2013, the total NLBI clinic attendances were 90. All cases were given biologic infusion safely and successfully without any adverse effects. Patients saved 45minutes in each visit since there is no need to wait for drug prescription and collection. The alternating follow-up arrangement also reduced doctor's workload by 50%. A questionnaire survey was administered to all recruited patients with 20 questionnaires collected (response rate 95.3%). 18 out of 20 (90%) patients either agreed or strongly agreed that adequate pre-treatment assessment was provided. Majority (19/20, 95%) of the patients reported that they have saved time in each attendance and 70% of them saved more than 30 minutes and 35% of them saved more than 1 hour. All participating patients (20/20, 100%) either agreed or strongly agreed that the overall Nurse-led Biologic Infusion Service was satisfactory. All of the patients agreed or strongly agreed that they would like to continue the service from rheumatology nurse.
Conclusions Nurse-led biologic infusion is smooth and safe. It saves patient's time in terms of the total duration of the treatment session. Furthermore, it spares the time of rheumatologists spent on routine visits and enables them to concentrate on the management of more complex cases.
Disclosure of Interest : None declared