Authors (including presenting author) :
Wong SMN(1), Tsang KF(1), Tin WY(1), Yeung SY(1), Lee AS(1), Wong CS(1)
Affiliation :
(1)Department of Clinical Oncology, Tuen Mun Hospital
Introduction :
Despite a global trend of reduced HBV infection, Southeast Asia remains endemic. A territory-wide study during 2015-2017 has reported a 7.8% local prevalence. Without prophylactic antivirals, the reported HBV reactivation risk during and after chemotherapy was 14-72%, with mortality from acute hepatitis of up to 60%. In order to align clinical practice with updated anti-viral prophylaxis guidelines, we have adopted the pilot auto-retrieval system for early detection of inadequate antiviral prescription with sequential standardized documentation integration.
Objectives :
(1) To review baseline clinic antiviral prescription compliance (2) To improve documentation and enhance antiviral prescription compliance (3) To compare clinical outcomes with baseline after the auto-retrieval and documentation integration
Methodology :
Starting from July 2018, the auto-retrieval system picked up pre-defined HBV patients on chemotherapy without adequate antiviral coverage, defined as coverage shorter than 182 days after chemotherapy end-date or 365 days after rituximab end-date. Manual screening by designated personnel followed to identify true positives and execute immediate remedies. Starting from early December 2018, doctors were required to indicate HBV status on patients’ written files and to indicate HBV status, antiviral plan as well as prescription on CMS clinical notes. Other entecavir prescription and clinic data were retrieved with CDARS. An audit cycle was conducted before and after December 2018 to compare prescription compliance.
Result & Outcome :
Between July 2018 and October 2019, a total of 31,652 chemotherapy clinic attendances were screened with an average HBV prevalence of 5.6%. Before standardized documentation, we identified an average inadequate entecavir prescription incidence/month of 0.765% (n=4), in which one patient was detected past period of necessary coverage and timely entecavir replacement was not possible. Re-audit post documentation standardization from December 2018 showed an improvement in compliance to both documentation and antiviral prescription with a reduced average incidence/month of 0.647% (n=8). The integration has also significantly shortened the inadequate antiviral coverage period from 81.3 to 17.1days and all patients were called back for prompt management. There were no overall adverse sequelae throughout the study period. Conclusion The integration of auto-retrieval system with manual documentation has led to a timely and robust antiviral coverage among HBV patients on chemotherapy. Future measures are warranted to gear towards 100% coverage.
