Standardising Infliximab Administration: a Comprehensive Care Plan to Improve Safety, Efficiency, and Quality of Care

Abstract

Infliximab, a TNF-a inhibiting monoclonal antibody, is widely used to treat various gastrointestinal (GI) and extra-GI inflammatory diseases by targeting core inflammatory pathways. However, due to its potential side effects and risk of infusion reactions, the current guidelines recommend comprehensive pre-administration screening, ongoing monitoring, and clear multidisciplinary communication and documentation. Current workflows often rely on prescribers or specialists to manually enter orders based on varying trust-specific checklists, leading to inconsistencies and inefficiencies. To address these challenges, we propose an order set in the form of a care plan to streamline and standardise the electronic prescribing process, enhancing efficiency and minimising errors. This care plan, developed in collaboration with the electronic prescribing and medicines administration (EPMA) team, is divided into two sections: (1) Pre-infusion screening, covering necessary blood tests and chest X-rays for infection screening and administration of vaccines where appropriate, and (2) Infusion monitoring and safety, which includes essential monitoring blood tests, safety medication, and clear documentation and equipment for nursing staff. Analysis of DATIX data across multiple sites at a major trust revealed 37 incidents, with 10 attributed to administration errors and at least 4 due to communication and scheduling issues. Implementation of this care plan aims to: . Reduce Medication Error: using standardised steps to minimise human error and support adherence to clinical guidelines. Improve Efficiency: due to the streamlined process, it prevents delays in prescribing. It also facilitates communication among the multidisciplinary team. Enhance Safety: by ensuring structured screening and prompt response to adverse events with medications on standby. Saves time: by expediting the electronic prescribing process, allowing staff to allocate more time to other tasks . Elevates Quality of Care: by providing consistency and reliability in treatment administration. By integrating this care plan, we aim to enhance patient safety, optimise resource use, and improve the overall quality of care for patients receiving infliximab.