IMPLEMENTATION OF AN EVIDENCE-BASED HYPERSENSITIVITY ALGORITHM REVISION IN AN ADULT AMBULATORY ONCOLOGY CLINIC.

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]