Fenton Tyler T, Crawford Brooke S, Bullington Susan M
is an Oncology Pharmacy Resident; and and are Clinical Pharmacy Specialists; all at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana.
Fed Pract. 2020 Jul;37(7):331-335.
The use of IV rituximab for the treatment of a variety of malignant and nonmalignant indications has been associated with significant challenges related to time and labor. To help alleviate some of these logistic challenges, institutions have implemented protocols to shorten the time in which rituximab is infused. The purpose of this study was to support the safe implementation of a 90-minute rapid infusion protocol for rituximab at the Richard L. Roudebush VA Medical Center (RLRVAMC).
A 90-minute rituximab protocol was developed, and proactive measures were taken to educate physicians, pharmacists, and nurses on ordering, processing, compounding, and administering rituximab. A weekly report of patients who received rituximab at RLRVAMC was generated November 1, 2018 through April 1, 2019. Patients then were screened for rapid infusion of the drug based on eligibility criteria, and health care providers (HCPs) were notified. After each patient received a rapid infusion, a retrospective chart review was performed to evaluate patient tolerability and assess for any safety concerns that would require protocol modification. The primary endpoint for this study was the incidence of grade 3 and 4 infusion-related reactions (IRRs) associated with rapid infusions of rituximab based on the Common Terminology Criteria for Adverse Events Version 5.0.
Eleven patients received 24 rapid infusions of rituximab. Of these infusions, 1 (4.2%) resulted in a grade 3 IRR; no infusions resulted in a reaction of grade ≥ 4. The use of rapid infusion of rituximab when compared with nonrapid infusion saved 39.3 minutes on average per patient.
The proactive measures that were used to implement the rapid infusion rituximab protocol improved HCP prescribing rates, nursing satisfaction, and the management of IRRs. This study confirmed appropriateness of rapid administration of rituximab in this veteran population and has increased interest in implementing other rapid infusion protocols.
静脉注射利妥昔单抗用于治疗多种恶性和非恶性疾病时，在时间和人力方面面临重大挑战。为帮助缓解其中一些后勤方面的挑战，各机构已实施相关方案以缩短利妥昔单抗的输注时间。本研究的目的是支持理查德·L·鲁德布什退伍军人事务医疗中心（RLRVAMC）安全实施90分钟快速输注利妥昔单抗方案。
制定了90分钟利妥昔单抗方案，并采取积极措施对医生、药剂师和护士进行关于利妥昔单抗的医嘱开具、处理、配制和给药方面的培训。2018年11月1日至2019年4月1日生成了RLRVAMC接受利妥昔单抗治疗患者的每周报告。然后根据入选标准对患者进行快速输注该药物的筛查，并通知医疗保健提供者（HCP）。每位患者接受快速输注后，进行回顾性病历审查以评估患者耐受性，并评估是否存在需要修改方案的安全问题。本研究的主要终点是根据不良事件通用术语标准第5.0版，与利妥昔单抗快速输注相关的3级和4级输注相关反应（IRR）的发生率。
11名患者接受了24次利妥昔单抗快速输注。在这些输注中，1次（4.2%）导致3级IRR；没有输注导致≥4级反应。与非快速输注相比，利妥昔单抗快速输注平均每位患者节省39.3分钟。
用于实施利妥昔单抗快速输注方案的积极措施提高了HCP的处方率、护理满意度以及IRR的管理。本研究证实了在该退伍军人人群中快速给予利妥昔单抗的适宜性，并增加了对实施其他快速输注方案的兴趣。
