The Ocrelizumab Pharmacy Service at the Leeds Teaching Hospitals NHS Trust (LTHT): Improving the Patient Experience


By Jeremy Robson & Sumrah Shaffiq, Advanced Clinical Pharmacists, Leeds Teaching Hospitals NHS Trust

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Aim

To review the West Yorkshire MS Treatment Programme’s (WYMST) ocrelizumab pharmacy service in order to:

  • Understand the patient experience on the day unit
  • Ensure timely availability of infusions
  • Establish a safe and appropriate pace to compound ocrelizumab infusions
  • Ensure safe and effective ocrelizumab prescribing

Headlines

  • Ocrevus (ocrelizumab) was approved for relapsing-remitting MS (RRMS) in 2018, and for early primary progressive MS (PPMS) in 2019
  • At WYMSTP, patients eligible for ocrelizumab are consented by MS nurses and receive treatment on the LTHT day unit along with patients with other neurological conditions. Independent prescribing pharmacists (IPP) undertake prescribing, using paper charts, by liaising with LTHT aseptic services
  • The approval of ocrelizumab means a potential increase in prescribing, day case admissions, and aseptics involvement in the manufacture of monoclonal antibodies (MABs)

Key findings

Between 1 November 2018 and 31st December 2019:

  • 92 doses of ocrelizumab were administered
    • 63 RRMS patients received ocrelizumab infusions
    • IPPs spent around 10 mins prescribing the infusion on the paper chart
    • The average time it took for the infusion to arrive in the day unit was 155 mins (range: 63 minutes to 289 minutes)
  • A patient survey found that the overall experience was good, but the wait time was a bone of contention for many
  • A staff survey found most doses were compounded by nurses on their own units, rather than the day unit

Recommendations

  • Pilot pre-making ocrelizumab in aseptics within 24 hours of the patient’s appointment and ascertain if the improved patient experience outweighed the potential financial risk
  • Evaluate how the ChemoCare electric prescribing pilot, currently being undertaken at LTHT, could benefit other day case treatments, including ocrelizumab
  • Collaborate with the aseptics unit to establish an electronic alternative to paper charts for prescribing ocrelizumab

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Encouraging excellence, developing leaders, inspiring change

MS Academy was established six years ago and in that time has accomplished a huge amount. The six different levels of specialist MS training are dedicated to case-based learning and practical application of cutting edge research. Home to national programme Raising the Bar and the fantastic workstream content it is producing, this is an exciting Academy to belong to.