Immunotherapy Guide Increases Dosing Accuracy
Saturday, March 5, 2016: 3:00 PM
Room 404AB (Convention Center)
Jared I. Darveaux, MD, , ,
Rationale: Immunotherapy (IT) is an effective therapeutic tool used to treat allergic disease. Proper dosing of IT is important for optimizing patient results and minimizing the risk of shot reactions/anaphylaxis. In 2011, practice parameters (PP) were published with dosing recommendations for standardized and non-standardized antigens. We launched a quality improvement initiative to study current prescribing practices and develop a decision support tool (DST) to improve dosing accuracy. 

Methods: Developed a DST to provide a dosing guide based on PP guidelines. Education was provided in the form of 1:1 coaching, didactic training sessions and real time guidance. Prior to implementing the DST, 50 most recent new IT prescriptions were reviewed (excluding venom) and were categorized as either accurate (in accordance with PP guidelines), high, very high, low, or very low. The DST was then placed in clinics for optional use by providers. After 4 months, the 49 most recent prescriptions were reviewed and compared to pre-implementation values using chi-square analysis. 

Results: Prior to DST use, 28% of prescriptions were accurately dosed. The majority of prescriptions (38%) were dosed very low (less than ½ lowest recommended dose). After DST implementation accurate dosing improved by 143% (p = < 0.0001). There were also significant reductions in very high (60%, p = <0.0001) and very low (79%, p = <0.0001) doses.

Conclusions: Implementation a DST dramatically improves the accuracy of IT dosing. A bundled approach of education, coaching and decision support linked to the ordering process leads to better adherence to guideline recommendations.