Advanced therapy screening in inflammatory bowel disease and the impact of clinical nurse specialists: A retrospective analysis of electronic patient records

TL;DR

This study shows that more clinical nurse specialists in IBD services improve infection screening compliance and reduce treatment delays.

Contribution

The study provides evidence linking CNS staffing levels to better adherence to infection screening and faster treatment initiation in IBD.

Findings

Increased CNS staffing correlates with improved compliance with pre-treatment infection screening.

Higher staffing levels reduce the time from treatment decision to administration of advanced therapies.

Only 8% of patients had positive screening results, all with known clinical risk factors.

Abstract

•IBD clinical nurse specialists (CNS) play a pivotal role in starting advanced therapies in IBD, including the crucial step of pre-treatment infection screening to avoid reactivation of latent of infections.•We have demonstrated that increasing staffing levels significantly improves compliance with pre-treatment screening.•Improved staffing levels also reduce the time taken from the decision to start an advanced therapy to the initiation of treatment.•Despite this, IBD services across the UK are understaffed with regards to CNS and specialist pharmacists.

IBD clinical nurse specialists (CNS) play a pivotal role in starting advanced therapies in IBD, including the crucial step of pre-treatment infection screening to avoid reactivation of latent of infections.

We have demonstrated that increasing staffing levels significantly improves compliance with pre-treatment screening.

Improved staffing levels also reduce the time taken from the decision to start an advanced therapy to the initiation of treatment.

Despite this, IBD services across the UK are understaffed with regards to CNS and specialist pharmacists.

Advanced therapies (AT), encompassing biologics and small molecules, are a common and important treatment for inflammatory bowel disease (IBD). However, these treatments pose a risk of reactivating latent infections and therefore require pre-treatment infection screening, but compliance with this screening has previously been reported to be poor. Clinical nurse specialists (CNS) and pharmacists play a key role in facilitating this screening and safely initiating AT, but are understaffed compared to national standards. Through retrospective review of electronic patient records at St George’s University Hospital, a tertiary IBD centre in London, UK, we evaluated the impact of staffing on rates of compliance with screening and time from prescription to administration of AT (TAT). 1,035 patients with IBD treated with an AT were identified, and we found a significant correlation between increased CNS staffing and improved screening compliance, as well as a numerical reduction in the TAT. Incidental findings were relatively low, with 8% of patients presenting positive results, all of whom had clinical risk factors. The study advocates for increased staffing and resources in IBD services to enhance patient safety and treatment efficacy.

Image, graphical abstract

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