Tyler T Fenton1, Brooke S Crawford1, Susan M Bullington1. 1. is an Oncology Pharmacy Resident; and and are Clinical Pharmacy Specialists; all at the Richard L. Roudebush VA Medical Center in Indianapolis, Indiana.
Abstract
BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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