A Golden Ticket for Closer Surveillance of Patients on Natalizumab
FDA safety guidelines for patients receiving infusions of natalizumab (Tysabri) for the treatment of Multiple Sclerosis require physician visits and MRI imaging at regular intervals due to the ‘black box warning’ for progressive multifocal leukoencephalopathy (PML). Although dates of MD visits and imaging are tracked by the MS infusion nursing team, some patients continue to miss their appointments, potentially increasing their risk.
Our aim was to improve patient adherence to safety monitoring protocols. To accomplish this, we implemented a ‘Golden Ticket’ system, in order to improve communication between infusion RNs and schedulers, and to more proactively engage patients in safety management.
The Golden Ticket worksheet outlines requirements for MS neurologist appointments (typically every 3 months, but at least every 6 months) and yearly MRI scans. At check in, registration staff writes in when the patient last saw the neurologist, when the next MRI is due, and dates of upcoming exams already scheduled. Patients then carry the Golden Ticket to the infusion suite and hand it off to an infusion RN. The infusion RN together with the patient reviews the Golden Ticket to ensure adherence to FDA safety guidelines.
We note that prior to using the Golden Ticket system, multiple patients fell behind recommended intervals for safety monitoring. Since implementing the Golden Ticket, which involves patient registration staff and infusion RNs in the process of surveillance, more patients see their neurologist and obtain imaging within the recommended time frames.
In our practice, infusion RNs verify patients receiving natalizumab have had a follow up visit with their neurologist and MRI imaging within the recommended intervals prior to completing TOUCH reauthorization. Engaging patient registration personnel by use of our Golden Ticket at each Tysabri infusion appointment provides early warning when patients are coming due for visits or imaging and increases opportunities to get patients scheduled. This system and team approach also provide extra time that may be needed to overcome barriers to care, including access to appointment times or need for financial assistance. Ensuring recommended surveillance protocols are followed during natalizumab treatment improves safety and potentially lowers the risk of morbidity and mortality related to PML.