Congress Abstracts 2006

79

ABBREVIATED INFUSION RITUXIMAB: LESSONS LEARNED AND WAYS FORWARD. Tracy Nagy, RN, BScN, MN, Princess Margaret Hospital, Toronto, Canada.

The anti-CD20+ monoclonal antibody rituximab is widely used in the treatment of lymphomas. Initially, a prolonged infusion schedule was recommended because of the potential for serious infusion reactions with the first dose. Expansion of the indications for use of rituximab has implications for timely scheduling of treatment, patient satisfaction and nursing workload. Recent data have demonstrated safety with an abbreviated infusion schedule over 90 minutes or less. The infusion practice differs across oncology units in Ontario. Evaluation of the implementation of this practice at our centre reveals that practice is influenced by nurses' experience, knowledge, preferences and fears.

To discuss the problems associated with abbreviated rituximab infusion and the subsequent development of practical tools to support nurses with this practice change. As a teaching centre, our mandate is to support oncology nursing practice both locally and in surrounding community oncology units.

Documentation of the experience with abbreviated infusion for 50 patients was reviewed. Clinical grading of reactions is inconsistent and subjective with narrative documentation making evaluation of reactions difficult. These observations influenced the implementation of formal nursing education and the development of tools to provide objective documentation of reactions and an algorithm to allow consistent treatment of infusion reactions. These tools were reviewed with nurses both locally and at surrounding oncology units.

Nursing education and documentation tools are critical to support changes in bedside nursing practice. Abbreviated infusion requires standardized grading of reactions. Lack of knowledge and fear of reactions are deterrents to more efficient infusion practice.

The use of rituximab in lymphoma is expanding. Educational support is an essential component to a successful change in policy and practice prior to implementation. The development of a documentation tool and algorithm provided a framework that supported more autonomous, consistent and efficient practice at the bedside. The utilization of a toxicity-grading format provided more objective documentation and understanding of infusion reactions. Oncology nurses in surrounding units support the change in practice with the addition of educational support and useful documentation and decision tools.