Abstract Details

Glucocorticoids are prescribed in the (iNMD) clinic. Currently, there is lack of uniformity and evidence-based practice regarding counseling, monitoring parameters, and prophylactic medications when prescribing glucocorticoids. Glucocorticoids are linked to many short and long term, reversible and irreversible side effects. These side effects have impact on morbidity and mortality for our patients. Following evidence-based guidelines on monitoring and prescribing prophylactic medications can mitigate these side effects.

Reduce glucocorticoid related toxicity and poor patient outcomes by increasing uniformity and evidence-based practice when prescribing glucocorticoids in adult immune-mediated neuromuscular disorders (iNMD) clinic.

Our initial step included a literature review to create guidelines around glucocorticoid monitoring. Literature was sparse in neuromuscular disorders, and data was collected largely from the rheumatology literature. We identified four areas of intervention: (1) Bone health, (2) baseline blood work including evaluation for infectious disorders, (3) GI prophylaxis and (4) PCP prophylaxis. 

Our second step was to present our data to the iNMD clinic providers and prospectively monitor for recommendation compliance.  

We identified one primary recommendation (vitamin D and Calcium initiation), which we would monitor for compliance, as well as secondary recommendations.   

To improve compliance, we created resources including smartphrases in EPIC medical record system, a print out of summary of recommendations in workroom, and patient handouts. 

We worked with our institution to explore efficient tools for data collection, and used the edge reporting system.

~55% of patients on glucocorticoids therapy were recommended vitamin D and calcium at baseline. This increased to 85% at seven months post intervention. 

Moving forward, we will continue to follow the data and review outliers, including root cause analysis. We will expand to include our secondary recommendations, review data for other immunomodulatory treatments, and expand outside the iNMD clinic within neuromuscular, neurology, and eventually to other divisions.