1. Network Audit on Virology Testing prior to R-Chemotherapy in patients with newly diagnosed DLBCL
January to June 2016
Presented by Karan Wadhera

2. Guideline
a) All patients starting treatment with Rituximab should be screened for Hepatitis B virus infection, with testing for HBsAg and HBcAb a minimum, prior to commencing treatment- MHRA article Dec/2013 
b) All patients starting treatment with R-CHOP chemotherapy should have Hepatitis B and C screening, prior to commencing treatment- SWSCN Protocol
c) Routinely offer and recommend an HIV test to everyone attending their first appointment, for services providing treatment for Lymphoma- NICE guidance, Dec/2016

3. Aim
To achieve a target of 100% compliance in screening for Hepatitis B and C infections prior to commencing Rituximab based treatment, with a minimum of HBsAg, HBcAb and Anti-HCV Ab tests being done, prior to treatment in patients with newly diagnosed Diffuse Large B Cell Lymphoma.

4. Patients
All patients with a diagnosis of Diffuse Large B Cell Lymphoma, diagnosed between 01/January/2016 to 30/June/2016 and starting Rituximab based chemotherapy in the South West region, covering the following NHS Trusts:
UH Bristol NHS Foundation Trust
North Bristol NHS Trust
Royal United Hospital Bath
Gloucestershire Royal Hospitals NHS Trust
Great Western Hospital, Swindon
Musgrove Park Hospital, Taunton
Weston General Hospital, Weston-Super-Mare

5. Method
Individual Trusts involved in the audit, to complete an audit data collection sheet and to also include their local Trust policies and guidelines on virology testing.
The completed proformas are then to be returned to Karan Wadehra at and

6. Audit Data Collection Sheet

7. Results University Hospitals Bristol NHS Foundation Trust
 a) Total number of patients: 20
 b) Compliance with Hepatitis B and C screening: 9 (45%)

8. c) Non compliant cases
HBcAb not checked ?wrong ICE request
Oversight
d) HIV testing compliance: 95%

9. North Bristol NHS Trust a) Total number of patients: 11 (one patient discounted in view of date of R-Chemotherapy not available) b) Compliance with Hepatitis B & C screening: 8 (75%)

10. c) Non compliant cases: 3 patients
All three patients: Anti HCV not tested ?oversight ?requesting error
d) HIV testing compliance: 100%

11. Royal United Hospital, Bath a) Total number of patients: 19 (one patient discounted in view of being private patient) b) Compliance with Hepatitis B & C screening: 0% c) Non compliant cases
HBcAb testing not in Trust guidelines
No Hepatitis test requested in others- OS, NA
d) HIV testing compliance: 79%

12. Weston General Hospital a) Total number of patients: 8
 b) Compliance with Hepatitis B & C screening: 100%
c) HIV testing compliance: 100%
WELL DONE!

13. Gloucestershire Royal Hospitals NHS Trust
 a) Total number of patients: 20
 b) Compliance with Hepatitis B & C screening: 17 (85%)
c) Non compliant cases: 3 cases, Oversight (requested by clinician but not
performed)
d) HIV compliance: 30%: low rates of HIV testing

14. Musgrove Park Hospital, Taunton a) Total number of patients: 17 b) Compliance with Hepatitis B & C testing: 11 (65%)
c) Non compliant cases: Oversight issue- 2 cases no HBcAb done, 1 case Hepatitis
screening after R-Chemotherapy commenced
d) HIV testing compliance: 80%

15. Great Western Hospital, Swindon NO DATA!

16. Conclusions 1. ‘Oversight’ issue
2. HBcAb testing not in RUH Bath Trust guidelines
3. ICE requesting issue in UH Bristol
4. Low rates of HIV testing in Gloucestershire Royal Hospital

17. Recommendations
1. Better education of junior medical staff- Induction, SpR training day etc. 
2. MDT- Once R-Chemotherapy agreed in MDT, comment for clinicians to test for Hepatitis B & C. CNSs could request this after MDT
3. Lymphoma Nurse Specialists- can also request, while giving information to patients regarding R-
Chemotherapy
4. Check box on electronic chemotherapy prescribing systems, for clinicians, who are prescribing first cycle
of R-Chemotherapy
5. Pharmacy to flag up on chemotherapy chart- not issue chemotherapy until valid and appropriate
Hepatitis testing done
6. Check box on chemotherapy chart for first cycle of R-Chemotherapy, for administering nursing staff to
ensure that Hepatitis screening done
7. RUH Bath to incorporate HBcAb testing into Trust guidelines for patients commencing on R-
8. UH Bristol should incorporate a check box for Rituximab, while requesting Hepatitis B&C screening or
introduce the mandatory tests under Haematology profiles
9. All Trusts to routinely offer HIV testing, to all patients with a Lymphoma diagnosis, as per current NICE
guidelines.

18. Re-audit
Aim to re-audit in 6-12 months’ time, after above recommendations implemented at individual Trusts.
Re-audit to be presented at SWAG SSG meeting 2018.

19. Contributors Sophie Otton, North Bristol NHS Trust
Rebecca Hallam, Weston General Hospital
David Dutton, Royal United Hospital, Bath
Adam Bond, Gloucestershire Royal Hospitals NHS Trust
Deepak Mannari, Musgrove Park Hospital, Taunton
Helen Dunderdale, University Hospitals Bristol NHS Foundation Trust.