Endocrine Abstracts

Background: Nebido® (testosterone undecanoate) is frequently used for treating primary and secondary hypogonadism. Its safe long-term use requires structured, protocol driven monitoring. At King’s College Hospital, the Programmed Investigation Unit (PIU) delivers Nebido® treatment with patients allocated to either “standard” or “enhanced” pathways based on predefined biochemical thresholds as per local guidelines. We observed inconsistencies in pathway allocations and documentation, which prompted a quality improvement project aimed at enhancing clarity, safety, and efficiency.

Methods: A retrospective audit was performed of all Nebido® administrations between January and December 2024. Data were collected from EPIC, CITO and LCR for demographics, indication, pathway allocation, dosing interval, monitoring (FBC, LFTs, PSA, testosterone) and completeness of PIU documentation. Patients who received ≤1 injection or were discharged to external providers were excluded. Findings were compared with the local Nebido protocol, which delineates criteria for pathway assignment and recommended monitoring intervals.

Results: Seventy-eight patients met inclusion criteria; 56 (72%) were managed on the standard pathway and 22 (28%) on an enhanced pathway. Approximately 20% of the allocations showed partial deviation from protocol, most commonly escalation to enhanced monitoring for isolated elevated haemoglobin with normal haematocrit. Despite the guidance suggesting annual monitoring once stable, many patients on standard-pathway were monitored frequently with blood tests at nearly every visit. Documentation of pathway, adverse effects, biochemical trends and follow-up plans was lacking in many of PIU entries, limiting clarity.

Conclusions: Rather than reflecting individual practice gaps, the findings did highlight system-level opportunities to standardize monitoring and documentation. A biochemical classification tool, EPIC SmartPhrases (.nebidooverview and .Nebido), and targeted education sessions were introduced to help identify the correct pathways more reliably and reduce unnecessary testing. We are doing a subsequent audit to evaluate improvements in documentation practices, monitoring frequency and adherence to the local protocol.