Background: CMV infection can be prevented in most SOT recipients providing that a prevention protocol is followed. We discovered that our center's protocol, which includes proper antiviral drug dosing and CMV blood PCR monitoring, was not being uniformly followed, resulting in preventable CMV complications. Reduction of post-transplant infection was identified at our institution as a target for concerted effort to eliminate preventable harm. In June 2015 a nurse practitioner (NP) was hired to support these efforts, which included development of educational tools, electronic medical record (EPIC) based patient monitoring and enhanced continuity of care. We report our experience utilizing this approach to improve adherence with a CMV prevention protocol in CMV D+/R- patients.

Interventions: Using Lean Sigma methods we formed a multidisciplinary CMV prevention care improvement committee, assigned an NP oversight over CMV protocol utilization and created a CMV D+/R-report in EPIC that provides alerts regarding dose of valganciclovir, renal function and whether a patient is undergoing timely CMV PCR monitoring.

Results: 83 consecutive CMV D+/R- patients transplanted between September 1, 2015 and November 30, 2015 were followed for one year. Dosing was appropriate in 87% of patients and remained stable throughout the process (upper and lower control limits =1 and 0.66). Adherence with CMV monitoring and overall protocol adherence were initially unstable, but attained long term process stability during 2016. CMV monitoring improved from 53% to 74% (p<0.01) between 2015 and 2016 and adherence with the overall protocol improved from 69% to 83% (p<0.01). Marked improvements were noted in patients impacted by implementation of the EPIC report (introduced in June 2017 and used clinically for patients transplanted after June 1, 2016): 57% to 84% (p<0.01) for CMV monitoring and 74% to 87% for the overall protocol (p<0.01).

Conclusion: Gains in adherence to a post-transplant prevention protocol can be achieved with addition of NP oversight of the process and enhanced with utilization of EPIC based tools. Such gains in adherence likely translate to improved CMV outcomes.

CITATION INFORMATION: Shoham S., Anderson S., Avery R., Belden M., Boyer L., Cochran W., Desai N., Holechek M., Kraus E., Langlee J., Spitz P., Marr K. Multidisciplinary Approach to Prevention of Cytomegalovirus (CMV) Complications in Kidney and Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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