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. 2022 Sep;11(3):e001886.
doi: 10.1136/bmjoq-2022-001886.

Increasing anti-S antibody testing: a quality improvement initiative with evolving COVID-19 guidelines

Ali M Alam  1   2 , Rebecca Lester  2   3 , Marie-Claire Hoyle  2 , Tom E Fletcher  2   3 , Paul Hine  2
Affiliations

Increasing anti-S antibody testing: a quality improvement initiative with evolving COVID-19 guidelines

Ali M Alam et al. BMJ Open Qual. 2022 Sep.

Abstract

Background: COVID-19 management guidelines are constantly evolving, making them difficult to implement practically. Ronapreve was a neutralising monoclonal antibody introduced into UK COVID-19 guidelines in 2021. It reduces mortality in seronegative patients infected with non-omicron variants. Antibody testing on admission is therefore vital in ensuring patients could be considered for Ronapreve as inpatients.

Local problem: We found that on our COVID-19 ward, 31.4% of patients were not having anti-S tests despite fulfilling the other criteria to be eligible for Ronapreve. This was identified as an important target to improve; by not requesting anti-S tests, we were forgoing the opportunity to use an intervention that could improve outcomes.

Methods: We analysed patient records for patients with COVID-19 admitted to our ward over 4 months to observe if awareness of the need to request anti-S increased through conducting plan-do-study-act (PDSA) cycles.

Interventions: Our first intervention was an multidisciplinary team (MDT) discussion at our departmental audit meeting highlighting our baseline findings and the importance of anti-S requesting. Our second intervention was to hang printed posters in both the doctors' room and the ward as a visual reminder to staff. Our final intervention was trust-wide communications of updated local COVID-19 guidance that included instructions for anti-S requesting on admission.

Results: Our baseline data showed that only 68.6% of patients with symptomatic COVID-19 were having anti-S antibody tests requested. This increased to 95.0% following our three interventions. There was also a reduction in the amount of anti-S requests being 'added on', from 57.1% to 15.8%.

Conclusions: COVID-19 guidelines are constantly evolving and require interventions that can be quickly and easily implemented to improve adherence. Sustained reminders through different approaches allowed a continued increase in requesting. This agrees with research that suggests a mixture of educational sessions and visual reminders of guidelines increase their application in clinical practice.

Keywords: COVID-19; Quality improvement; Quality measurement.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Line graph showing change in total anti-S requesting and on admission anti-S requesting throughout our study period.
See this image and copyright information in PMC

References

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    1. Medicines & Healthcare products Regulatory Agency . Summary of product characteristics for Ronapreve. Available: https://www.gov.uk/government/publications/regulatory-approval-of-ronapr... [Accessed 21 Feb 2022].
    1. Department of Health & Social Care . Antibody testing for SARS-CoV-2: key information. Available: https://www.gov.uk/government/publications/antibody-testing-for-sars-cov... [Accessed 21 Feb 2022].
    1. Randomised Evaluation of COVID-19 Therapy (RECOVERY) . RECOVERY trial finds Regeneron’s monoclonal antibody combination reduces deaths for hospitalised COVID-19 patients who have not mounted their own immune response. Available: https://www.recoverytrial.net/news/recovery-trial-finds-regeneron2019s-m... [Accessed 21 Feb 2022].

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