Tumor necrosis factor-alpha inhibitor (anti-TNF) serum medication levels have been found to enhance outcomes in individuals with inflammatory bowel disease. The purpose of this study is to report the quality improvement (QI) approaches utilised at the institution to enhance post-induction therapeutic drug monitoring (TDM) in children starting anti-TNF medication (infliximab and adalimumab), as well as the frequency of subtherapeutic anti-TNF levels. All patients starting anti-TNF treatment were identified and followed beginning in February 2016. The Institute for Healthcare Improvement Plan-Do-Study-Act cycle method was used to execute interventions to enhance TDM, such as the commencement of therapy plans for infliximab, real-time reminders for practitioners, and schedule changes for patients starting anti-TNF medications. To illustrate progress over time, statistical process control charts were utilised. Anti-TNF levels as well as the existence of antidrug antibodies were also measured. Using the QI approach, researchers increased post-induction anti-TNF TDM from 43% in 2015 to >80% at the end of 2017, with continuous improvement. TDM after infliximab treatment increased from 59 percent to 82 percent, while TDM after adalimumab treatment improved from 14 percent to 79 percent. In sum, 36% of all anti-TNF post-induction levels were 5 g/mL, with nearly 60% of infliximab post-induction levels being 5 g/mL.
They increased the use of anti-TNF post-induction TDM using incremental QI methods over time, nearing our objective of 90%. Subtherapeutic post-induction infliximab levels were frequent, indicating a high need for anti-TNF TDM and the possibility of dosage modification.
