Quality improvement project - Implementation of subcutaneous immunoglobulin in patients with haematological disorders and secondary immunodeficiency.

BACKGROUND: Immunoglobulins (Ig) play a crucial role in the immune system's ability to fight infections. In incidences when their production and function is disrupted, such as in secondary immunodeficiency (SID), patients often face increased frequency and severity of infection, particularly respiratory tract infections. Ig replacement therapy administered intravenously (IVIG) or subcutaneously (SCIG) is recommended for treatment of SID, including SID caused by haematological malignancies. Subregional Ig assessment panels (SRIAPs) and prefilled syringes (PFS) for SCIG may positively impact services across the Trust and wider National Health Service (NHS) and increase patient satisfaction and treatment outcomes. OBJECTIVES: Investigate the improvement in service delivery and patient satisfaction following the switch from IVIG to SCIG PFS manual push in patients with SID following an East of England Immunoglobulin Assessment Panel (EOE IAP) review. DESIGN: Following establishment of the EOE IAP, three cohorts of patients with haematological disorders and SID, currently receiving IVIG across the Mid and South Essex NHS Foundation trust, were reviewed before switching to SCIG PFS. This manuscript reports the findings from one of the three cohorts, based at Broomfield Hospital. METHODS: Following clinical screening, patients were reviewed by the local SRIAP to assess Ig use and suitability for transfer from IVIG to SCIG PFS. Patient outcomes and satisfaction, financial measurements, and prescribing information after transition were recorded. RESULTS: SRIAP review of Ig prescribing for ten patients resulted in six transitioning from IVIG to SCIG PFS. Patients reported improved infection rates and satisfaction with home-based SCIG PFS treatment. Service outcomes reported savings in prescribing, pharmacy, and nursing time, as well as an increase in therapy chair capacity. CONCLUSION: SRIAP reviews and switching to SCIG PFS can improve patient satisfaction and outcomes, help clinically vulnerable patients shield via home-based treatment, improve service efficacy and lower total treatment costs, whilst promoting Ig stewardship.