Congress Abstracts 2005

59

IMPLEMENTATION OF AN INNOVATIVE NEW PROTOCOL TO DESENSITIZE PATIENTS SENSITIVE TO TAXOL/CARBOPLATIN. Ruth Muller, RN, MSN, Julio Toro, BSN, Lana Callahan, RN, OCN^®, Michelle Ciszewski, RN, BSN, OCN^®, and Karen Lynch, RN, BSN, Brigham & Women’s Hospital, Boston, MA.

The combination regimen taxol/carboplatin has been shown to increase survival time by as much as 50% in women with advanced ovarian cancer. Unfortunately, 6% of patients have experienced an allergic reaction to either or both of these drugs. At Dana-Farber Brigham Woman’s Cancer Center, (DFBWCC) inpatient oncology nurses are carrying out a new desensitization protocol designed to allow these drugs to be safely administered to patients who have demonstrated an allergic response..

This presentation describes an innovative protocol that guides nurses to safely administer taxol/carboplatin to those patients who have previously shown sensitivity to these drugs.

The oncology attending writes an order delineating the target chemo dose and the allergy fellow executes a computerized order process detailing three to five bags of precisely timed “stepped” doses of chemotherapy. Prior to initiating the protocol, the nurse performs an initial assessment focusing on symptoms experienced during the previous reaction and administers premedications. She then executes the intricate protocol, reassessing the patient constantly particularly as the rate or concentration is escalated. In addition to clinical skills, the nurse’s ability to provide an empathetic presence reducing the patient’s acute anxiety is paramount to the successful completion of the protocol. Patients are monitored for arrhythmias and vital signs are obtained every time there is a change in concentration and/or rate.

The intensive care unit is the setting for the first desensitization and if successful, subsequent administrations are done in an intermediate care unit with a 1:1 nurse.

Over 200 desensitization’s to chemotherapy agents have been completed at DFBWCC over the past 3 years; 97% of which have been successful and 3 % have required modifications to the protocol.

Although a patient who has once had a reaction to a drug will remain allergic despite being desensitized, the goal of desensitization is to allow the patient to be able to tolerate a select dose on the specific day of administration. This presentation, using illustrative cases, will describe an innovative new protocol that provides the means for achieving this goal.