Management and Follow up of Patients on Biologic Treatment for Rheumatological Disease Who Have Been Admitted to Hospital Acutely
Kerry Aston, Philip Gardiner, Rosemary Friel
Rheumatology Altnagelvin Hospital
Audit of the Management and Follow up of Patients on Biologic Treatment for Rheumatological Disease Who Have Been Admitted to Hospital Acutely.
1-Was biologic medication clearly documented in patient notes 2-Reason for admission 3-Was advice given by rheumatology team regarding possible suspension of medication
Search using H&C numbers – 39 patients had been admitted acutely between Jan and Jun 2014.
One death occurred from severe community acquired pneumonia. 12 patients were documented as having acute infections, one was admitted after an RTA (compound fracture). Treatment with biologics was suspended in all cases with infection. The rheumatology team were informed about all of the admissions.
Six other acute admissions for variety of reasons: 2 with MI (biologics continued), 1 with AF (Rituximab), 1 with raised LFTs (biologic suspended). One patient on Abatacept had been admitted with acute vertigo. 21 patients were admitted electively, 10 of which were for elective orthopaedic procedures. Of the 10 elective orthopaedic admissions, all had RA. There were 2 THRs, 2 TKRs – biologics suspended appropriately. There was one traumatic wrist fracture, one arthrodesis of MTPs. Of the elective non-orthopaedic admissions, 2 were lap cholecystectomies (treatment held), 2 were ENT procedures, one repair of hernia surgery (treatment held), one reversal of ?Hartman’s (treatment held). In one case a new diagnosis of colon cancer was made.
1. Poor documentation of biologic treatment in discharge summary.
2. Biologics therapy was not highlighted in ECR
3. The communication with the rheumatology department was good (12/12 acute infection)