A systematic checklist approach to immunosuppression risk management: An audit of practice at two clinical neuroimmunology centers

• Published in: Journal of neuroimmunology Vol. 312; pp. 4 - 7
• Main Authors: Mori, Amelia M., Agarwal, Smriti, Lee, Monique W.M., Rafferty, Martina, Hardy, Todd A., Coles, Alasdair, Reddel, Stephen W., Riminton, D. Sean
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.11.2017
• Subjects: Audit; Australia; Checklist; Clinical Audit - methods; Clinical Audit - standards; Cohort Studies; Cross-Sectional Studies; Female; Humans; Immune System Diseases - epidemiology; Immune System Diseases - mortality; Immune System Diseases - physiopathology; Immunosuppression; Male; Patient safety; Risk Management; United Kingdom; CLIPPERS; Audit; Immunosuppression; ANCA; ND; ISS; Patient safety; Checklist; Risk management
• ISSN: 0165-5728; 1872-8421
• DOI: 10.1016/j.jneuroim.2017.08.009

There is no consensus approach to safety screening for immune intervention in clinical neuroimmunology. An immunosuppression risk evaluation checklist was used as an audit tool to assess real-world immunosuppression risk management and formulate recommendations for quality improvements in patient safety. Ninety-nine patients from two centres with 27 non-MS diagnoses were included. An average of 1.9 comorbidities with the potential to adversely impact morbidity and mortality associated with immunosuppression were identified. Diabetes and smoking were the most common, however a range of rarer but potentially life-threatening co-morbid disorders in the context of immunosuppression were identified. Inadequate documentation of risk mitigation tasks was common at 40.1% of total tasks across both cohorts. A routine, systematic immunosuppression checklist approach should be considered to improve immunosuppression risk management in clinical neuroimmunology practice. [Display omitted] •Relevant comorbidities in immunosuppression risk management are collectively common, diverse and easily overlooked.•Our audit reveals deficiencies in risk assessment task completion in routine practice in two separate neuroimmunology clinics.•A routine checklist approach should be considered to improve immunosuppression risk management in neuroimmunology practice.