Analysis of daratumumab reporting in type and screen orders to identify opportunities for information system improvement

Abstract

The rapid growth of monoclonal antibody therapies has resulted in a wide variety of targeted treatments towards malignancies. The presence of these antibodies in patient plasma can interfere with blood bank testing, which in turn can create a delay in the process of pretransfusion testing and provision of blood products to patients. Availability of information regarding particular medications can help guide blood bank processes and testing algorithms. Reporting of patient medications that can interfere with blood bank testing, including targeted therapeutic antibodies (e.g. anti-CD38 therapies such as daratumumab), often relies on the ordering provider to provide that information. At our institution, the type and screen (T&S) order contains a prompt that requests the history of daratumumab administration. Available responses are “yes”, “no”, or “unknown”, with the default answer of “unknown”. The goal of this study was to evaluate the reporting practice of daratumumab history in the T&S order and identify potential areas for process improvement. We retrospectively reviewed T&S orders for patients receiving daratumumab therapy during 2022 at a single institution. Of 370 patients who were receiving daratumumab therapy, 214 (57.8%) had T&S orders. Forty of the 214 patients (18.7%) with T&S orders had at least one order with a “yes” answer indicating daratumumab administration. Of the 40 patients with an answer of “yes”, 16 (40%) were associated with the initial T&S after starting therapy. Of the other answer options, 23 of 40 (57.5%) indicated “unknown” and 1 (2.5%) indicated “no”. The remaining T&S orders ordered after the initial order were evaluated for consistency in response. Of 352 total T&S orders placed after the initial T&S orders, 62 (17.6%) were “yes” answers, 4 (1.1%) were “no” answers, and 286 (81.3%) were “unknown”. These results suggest that manual reporting of daratumumab therapy is not optimized at time of initial T&S orders placed after daratumumab treatment is started and is further misaligned with treatment status with subsequent T&S orders. Development of automated methods may help improve the process of reporting medications to the blood bank to guide testing. Future directions include development of an informatics-based approach to link the patient’s medical administration record (MAR) to the laboratory information system (LIS) to provide history of daratumumab therapy to the blood bank. This approach will prioritize: (1) compatibility with the blood bank’s current workflow for testing, (2) clinical needs for ordering laboratory testing, and (3) adaptability for reporting of other relevant interfering therapies to the blood bank as well as to other clinical laboratories.