Improving patient safety and engagement with hepatitis B screening.
Pharmacist Recognition Prize Winner
“Pharmacist-led Interventions to Improve Compliance with Hepatitis B Screening Prior to Starting Rituximab.”
Upon starting her role as a Clinical Pharmacist in Gastroenterology and Hepatology, Ms Turley inherited an audit which had been triggered by a patient fatality within the Trust. This was due to hepatitis B reactivation (HBVr). The aim of the audit was to measure compliance to the recommendations of the MHRA Drug Safety Update in 2013, regarding the potentially fatal risk of HBVr associated with Rituximab. Rituximab is a biologic therapy, often used to treat auto-immune diseases that carries a known risk of HBVr.
Ms Turley explains:
All patients who had been supplied with Rituximab between 2013 and 2018 were reviewed and their screening status checked. The initial audit showed that only 60% of patients were screened for a current HBV infection (HBsAg) prior to starting Rituximab but, and more concerningly, only 14% were screened for a past infection (anti-HBcore) prior to starting Rituximab. Only 17% of those with positive serology were referred to hepatology.
As a result of this, Ms Turley developed and put into place several pharmacist-led interventions.
“Following this work, I recently carried out a re-audit of the original, this time reviewing all patients who had been supplied rituximab in 2022. My re-audit shows that almost 100% of this cohort of patients had been screened for both HBsAg and anti-HBcore prior to starting rituximab, and all but one with positive serotology were referred to hepatology. This clearly demonstrates the positive and lasting impact of the interventions that I put into place and therefore the improvement of patient safety.”
Why did you choose this project?
“I felt very passionately about the unacceptable risk being faced by some patients, and therefore developed and put several pharmacist-led interventions into place.
These included providing feedback from the audit to the key divisions who prescribe rituximab (rheumatology and haemotology/oncology) and teaching to Gastroenterology and Pharmacy to improve vigilance around hepatitis B reactivation.
I developed a local HBVr guideline to guide clinicians on the correct pathway whilst ensuring that referrals and queries regarding HBVr were directed to me. This provided the teams with easier access to hepatology advice, a prompt response to their query and improved the visibility of the hepatology team within the hospital.”
"It is very rewarding to see the improvement in engagement with hepatitis B screening from clinicians, and the clear impact this has on improving patient safety. It's great to be recognised by the Dr Falk/Guts UK award for all the work I have put into this, especially as I had to learn about hepatitis B reactivation as I went along.
Ultimately, I aim to become a consultant pharmacist in Hepatology and this award can help to support my portfolio."- Rebecca Turley