N20 Safety of extended blood monitoring for adult Inflammatory Bowel Disease (IBD) patients on oral azathioprine during the COVID-19 pandemic: a single-centre audit

Abstract

Background Azathioprine (AZA) is a recognised treatment option for maintaining remission in IBD patients. Myelotoxicity and abnormal liver function tests may present at any stage of therapy, therefore ECCO advises practitioners to check full blood count, liver and kidney function tests at 3-monthly intervals for patients established on therapy. During the COVID-19 pandemic, UK guidance suggested reducing blood test monitoring to a minimum safe frequency to facilitate ‘shielding’ of vulnerable patient groups. Patients established on treatment at St Mark’s Hospital for more than 12 months, on stable doses were deemed eligible for extended blood monitoring intervals of 6-monthly. The aim of this audit was to assess the impact of this extension on patient safety, by measuring outcomes against locally agreed standards. Methods All patients on AZA were identified using the pharmacy dispensing system and patient information software for blood test results, clinic letters and notes. Outcomes for patients who had extended blood monitoring were collected retrospectively including monitoring calls to the IBD advice line and any hospital admissions associated with therapy. Subsequent blood test results were also captured. Results A total of 92 patient records were identified and analysed. Table 1 shows the achieved compliance (%) to the audit standards compared to the target compliance (%). 54% of patients (n=50) received medication that lasted beyond the standard 12-week validity of a blood test, i.e. had extended blood monitoring. Of those 50 patients, 43 were eligible for extended blood monitoring (86%). From 50 patients with extended blood monitoring, one patient had elevated alanine aminotransferase levels which improved after a one-week treatment break. Another patient called the IBD advice line reporting nausea and abdominal cramps due to treatment and was advised to split the dose and monitor for side effects. No patients were admitted to emergency care or hospital due to deranged blood test results or adverse effects from their medication. Conclusion Overall the findings suggest that the temporary relaxation of blood monitoring did not adversely affect patient safety. For more comprehensive results, it would be prudent to repeat the audit using a larger sample size; however the audit has established a baseline at a time of unprecedented changes in the workplace, which will be useful in guiding future practice.