目的:静脉抗癌治疗可能与超敏反应和/或输注相关反应(IRR)有关,这些反应可能导致危及生命的症状。作为质量改进项目的一部分,肿瘤药剂师开发并实施了护士驱动,基于症状的IRR协议。评估的目的是评估在门诊输液中心实施基于症状的方案后IRR治疗失败。次要目标包括确定需要IRR治疗的最常见的抗癌药物,治疗后72小时内的急诊就诊或入院记录,由于IRR导致的死亡率记录,并评估同一药物是否有多个记录的IRR。
方法:共456例患者,对2014年2月至2018年3月期间在GradyHealthSystem(GHS)接受抗癌治疗的患者进行了回顾性评估.如果患者接受了用于肠胃外施用的抗癌剂的输注反应管理的方案特异性药物,则将其包括在内。主要结果是IRR治疗72小时内的治疗失败率。
结果:78名经历了108个IRR的患者被纳入分析。5%的内部收益率只包括严格的,57%的IRR为轻度/中度严重程度,除轻度/中度/严重反应外,31%的IRR为严重/过敏严重程度,7%的IRR为严酷反应。在108个IRR中,在72小时内观察到治疗失败的8种反应;其中6种在急诊科进行了评估,2种需要住院。总的来说,93%的反应在输液中心解决,患者出院回家;没有患者死亡。最常见的不良反应是紫杉醇和奥沙利铂。
结论:在实施新的药剂师开发后,基于症状的护士驱动协议,在评估的IRRs中,输注反应治疗失败的发生率为7%.虽然故障率很低,额外的护士教育和更好地获得方案指导的药物可能会优化方案的使用.
OBJECTIVE: Intravenous anticancer therapy can be associated with hypersensitivity- and/or infusion-related reactions (IRRs) which may result in life-threatening symptoms. As part of a quality improvement project, oncology pharmacists developed and implemented a nurse-driven, symptom-based IRR protocol. The objective of the evaluation was to evaluate IRR treatment failure after implementation of a symptom-based protocol in an ambulatory infusion center. Secondary objectives included determining the most common anticancer agents requiring IRR treatment, documentation of ED visits or hospital admissions within 72 h of treatment, documentation of mortality due to an IRR, and evaluating whether there were multiple documented IRRs to the same medication.
METHODS: A total of 456 patients, who received an infusion of anticancer therapy at Grady Health System (GHS) between February 2014 and March 2018, were retrospectively evaluated. Patients were included if they received a protocol-specific medication for infusion reaction management of a parenterally administered anticancer agent. The primary outcome was the rate of treatment failure within 72 h of treatment for an IRR.
RESULTS: Seventy-eight patients experiencing 108 IRRs were included in the analysis. Five percent of IRRs consisted of rigors only, 57% of IRRs were mild/moderate severity, 31% of IRRs were severe/anaphylactic severity and 7% of IRRs were rigors in addition to a mild/moderate/severe reaction. Of the 108 IRRs, treatment failure within 72 h was observed in eight reactions; six were evaluated in the emergency department and two required a hospital admission. Overall, 93% of reactions resolved in the infusion center and patients were discharged home; there were no patient deaths. The most common offending agents were paclitaxel and oxaliplatin.
CONCLUSIONS: Following implementation of a novel pharmacist-developed, symptom-based nurse-driven protocol, infusion reaction treatment failure occurred in 7% of IRRs evaluated. Although the failure rate was low, additional nurse education and improved access to protocol-directed medications may optimize use of the protocol.