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Cancer chemotherapy and immunotherapy is associated with infusion reactions, which are unplanned and range from mild, moderate to severe and life-threatening anaphylaxis. This is an oncologic emergency requiring the interdisciplinary team to have a well-developed, evidence-based approach, where all clinicians demonstrate competency and can respond immediately and ensure safe recovery from the reaction. First responders and the support team need to know their roles and responsibilities and depend on others to do the same during emergency reaction management. The purpose of this project was to share one institution's approach in reviewing and updating a hypersensitivity treatment algorithm in an adult ambulatory oncology clinic. An interdisciplinary team (nursing, pharmacy, allergy service) met to review current practice and outcomes associated with acute infusion reaction management. A literature search was conducted to update the algorithm with current evidence-based interventions needing to be adopted. Based on this review, the existing algorithm was updated, clinicians were educated, and a new algorithm was adopted and implemented. Key updates in this algorithm include: a standard grading scale for reaction severity, guidelines for medication administration based on symptoms and severity, when to draw tryptase levels, administration of glucagon for patients not responding to epinephrine taking beta-blockers, significance and appropriate use of epinephrine, when not to re-challenge with causative agent and the documentation of the allergen in the medical record. This presentation will describe the team review of current practice and evidence-based literature, interventions supporting algorithm implementation, the updated algorithm and ongoing implementation support strategies. Clinician education was the main intervention for implementation of a new acute infusion reaction management algorithm. One month before go-live, an online, interactive education module was assigned to nurses, physicians, pharmacists, nurse practitioners and physician assistants. Successful achievement of this education included completion of the interactive module and a passing test score of 100%. Evaluations of this offering will be presented along with ongoing strategies for compliance. Standardizing an approach for acute infusion reactions in oncology is equally as important as the standards in place for providing basic life support. Interventions must be based on evidence, roles and competency must be defined and re-evaluated and the interdisciplinary team needs to be involved at all phases of reaction management. [ABSTRACT FROM AUTHOR]

As authoritative resources on the optimal use of medications in symptom management, palliative care pharmacists exemplify several clinical, administrative, and educational roles within the outpatient clinic setting. Knowledge of medication-use processes allows pharmacists the ability to improve patient safety and outcomes. In 2018 a quality improvement project to optimize the scheduling of pharmacist-provider joint visits in the Dana-Farber Cancer Institute Outpatient Palliative Care Clinic led to overwhelming Adult Palliative Care (APC) provider satisfaction. Given this success and continued desire for pharmacy collaboration, the "PharmPAL" Clinic was initiated in July of 2020. PharmPAL is a collaborative drug therapy management (CDTM) clinic where credentialed pharmacists lead intermediary and follow-up palliative care visits encompassing patient assessments, counseling, education, ordering of laboratory tests, and selecting, initiating, continuing, and modifying medication regimens. The goal of PharmPAL is to support the growth of the palliative care clinic by providing care to patients with intense symptom management needs through interval visits with a pharmacist within their credentialed scope of practice, increasing the availability of follow-up to patients. Through a survey disseminated to all outpatient palliative care providers, reasons for referral for both joint visits and PharmPAL visits were gathered. Based on an overwhelming percentage of providers in favor of increasing PharmPAL visits, the weekly availability increased from eight 30 minute appointments per week in the first seven months to twelve 30 minute appointments each week. The top five reasons for PharmPAL referral include new consult requiring close follow-up, education and counseling, stable patient for refill review, schedule availability, and regimen or medication change in the previous visit or anticipated in visit. Barriers to utilizing PharmPAL include pharmacist availability, APC scheduling, and out-of-state patients. An increase in PharmPAL availability has led to an increased volume of patients and encounters for both PharmPAL and the outpatient clinic overall. Additional surveys will be employed to address feedback for ongoing areas for improvement in order to reach our goal of a 30% increase of PharmPAL referrals within the first three months and continued improvement in overall provider satisfaction with PharmPAL. As outpatient palliative care clinics are incorporating pharmacist-led visits into practice, identification of outcomes metrics is critical to the ongoing growth of these clinics. Over the next several months we plan to continue to assess the impact PharmPAL has on clinic operations and provider satisfaction in the Dana-Farber Cancer Institute outpatient palliative care clinic. [ABSTRACT FROM AUTHOR]