Implementing an electronic flowsheet for biologics requiring infusions and injections in inflammatory bowel disease.

BACKGROUND

Biologic medications for inflammatory bowel disease (IBD) may have complex dosing regimens requiring infusion dosing before transitioning to subcutaneous (SC) maintenance dosing. Transitions are time sensitive and require coordination of insurance approvals and medication access.

OBJECTIVES

The objective was to streamline workflow and improve data visibility and reporting capabilities by implementing an electronic health record flowsheet to manage patients initiating medication requiring induction infusion(s) prior to SC dosing.

PRACTICE DESCRIPTION: This innovation occurred at an academic health system IBD outpatient clinic with an integrated specialty pharmacy team and infusion pharmacist.

PRACTICE INNOVATION: In July 2022, a flowsheet was implemented to merge workflow documentation for infusion and specialty pharmacists. The flowsheet contained data fields to track key information in the patient journey. Flowsheet data were easily viewable and prompted alert messages for the specialty pharmacists when key milestones were documented. Before implementation, reporting of patient journey data would have required extensive manual chart review.

EVALUATION

METHODS

Postimplementation pharmacist surveys were conducted, and flowsheet data from July 5, 2022 to January 31, 2025 was extracted. A descriptive analysis was completed.

RESULTS

All pharmacists (n = 5) using the flowsheet completed a postimplementation survey. Overall satisfaction with the flowsheet was high [9.2 (scale of 0-10, 0 = strongly dissatisfied and 10 = strongly satisfied)]. All pharmacists strongly agreed (80%, n = 4) or agreed (20%, n = 1) the flowsheet increased visibility into patient's treatment status and strongly agreed (60%) or agreed (40%) that the flowsheet streamlined workflow. Postimplementation, previously unavailable data were pulled from the electronic health record. This allowed reporting of time from referral to first infusion dose [median 22 (interquartile range 15, 35) days] and capture rate for the institution's infusion centers (66%) and specialty pharmacy (52%).

CONCLUSION

Implementing a flowsheet with alerts to manage patients initiating biologics for IBD that require infusion(s) before switching to SC dosing streamlined workflow, increased visibility, and improved data capture.