A varied approach to the initiation, assessment and delivery of Omalizumab across the United Kingdom has been observed. To analyse the disparity in practize a questionnaire was disseminated to centres administering Omalizumab. Completed questionnaires n=43 (32.5% paediatric/67.5% adult). Questions asked were specific to the initiation, assessment and delivery of Omalizumab, the results identified a wide disparity in practize.
Adherence assessment prior to Omalizumab initiation was completed by all centres; however there was a varied approach of each centre in their assessment. 90.6% assessed prescription records, 74.4% questioned patients regarding medication adherence, 32.5% measured prednisolone levels and 4.6% utilised a validated questionnaire (4.6%) Longitudinally 48.8% continue to monitor adherence every 0–6 months, 27.9% every 6–12 months whilst 11.6% do not cheque adherence long term. Centres were diverse in their period of recommended observation post first dose. 4.6% advocate a 0–60 minute observation, 25.5% 1–2hrs, 39.5%, 2–3 hrs and 23.3% >4hrs, subsequent dose administration also varied across centre 37.2% advocated a 0–30min observation, 25.5% a 30–60min period and 11.6% 2–3hrs (11.6%). Paediatric centres advocated a longer observation period post injection. Across centres there is a huge inconsistency in weight observation 46.5% of centres weigh patients each visit, 27.9% 1–3 monthly and 16.2% 3–6 monthly. Dose of Omalizumab is only altered specific to weight fluctuation by 60.4% of which a higher percentage is practised in paediatric compared to adult centres (71.4%/55.1%). Out of dosing range prescribing is undertaken by 57.1% (paediatric) 29% (adult). Use of adrenaline auto injectors were not advocated by 60.4% of the centres, of the remaining 39.5% who advocate adrenaline auto injectors only 47% of this population have specific guidance relating to length of time to keep the injector available.
Results of this audit provide evidence for the requirement for national evidence based guidelines, to procure a standardised collaborative approach regarding the use of Omalizumab for patients with severe persistent allergic asthma, with this in situ best practise can be delivered throughout the United Kingdom.
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