Introduction Thiopurines are an unlicensed but recognised therapy for Inflammatory Bowel Disease (IBD). These drugs interfere with cell signalling and have significant side effects including leucopaenia, pancreatitis and hepatotoxicity. Therefore routine monitoring of blood is mandatory. Our Trust has guidelines (based on BSG guidelines) for the monitoring of Thiopurine therapy. Patients are monitored by a IBD Nurse specialist using a simple electronic database.
Methods Objective: To determine the effectiveness of the IBD Nurse database in ensuring that patients on Thiopurines are monitored according to Trust guidelines. A total of 900 patients with IBD attend our gastroenterology clinics. Of these 204 are on Thiopurines. Trust guidelines recommends weekly blood test monitoring for the first month starting Thiopurines. This is followed by monthly for the next 3 months and every 3 months subsequently. Patients latest blood results were collected over a two consecutive days in July 2011 for 204 patients. Patients more than 7 days late for blood tests were considered non-compliance with the guideline.
Results 182 (89%) patients were having their bloods monitored as per trust guidelines. However 22 patients (11%) were being monitored incorrectly, with a median of 68.5 (32.25–269.25) days overdue. 16 of these patients have a diagnosis of Crohn's Disease, the remaining six have Ulcerative Colitis. 14 (7%) patients had either deranged liver function tests or were neutropaenic.
Conclusion The current manual database is reliable as the majority of thiopurines patients were being monitored as per hospital guideline. However, 7% of abnormal blood results may not be recognised promptly and no action was taken. An automated database with automated reminder to patients who passed their blood test due date and electronic notice to the doctor responsible for the patient is needed to reduce the potential risk of harm to the patients.
Competing interests None declared.
Reference 1. Anon. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011;60:571–607.