Chemotherapy Desensitization Process and Opportunities

Chemotherapy desensitization is a procedure by which cancer patients can be safely reintroduced to medications that have previously induced infusion reactions. Desensitization has important implications for patients who may have limited options to treat their cancer. Historically, cancer patients with previous severe infusion reactions in the outpatient setting were admitted to the Intensive Care Unit (ICU) for one to two days for the desensitization protocol. During this time, trained inpatient oncology nurses would leave their unit to go to the ICU to administer the desensitization chemotherapy while an ICU nurse was still assigned to the patient. This process proved to be costly and inefficient. 

An Improvement Process Project with Safety and Efficiency in Mind

A multidisciplinary team was developed to establish a process to perform chemotherapy desensitization safely and efficiently in the inpatient oncology unit instead of the ICU, with the end goal to transition this procedure to outpatient infusions in the Clinical Cancer Center Day Hospital. Along with safety and efficiency, the project aimed to maximize resources, reduce cost and align with Froedtert Hospital’s nursing practice model. 

Members of this project team included oncology nurses, pharmacists and a medical oncologist who developed a new desensitization guideline, drug compounding tip sheets and inpatient to outpatient workflows. Nurses were educated on the new treatment plans and refreshed in the management of infusion reactions, including having rescue medications immediately available for timely reaction treatment. 

A Two-Phased Approach 

The project consisted of two phases. During phase one, chemotherapy desensitization was administered on the inpatient oncology unit with patients discharged the same day. Seventeen treatments were given safely. Patients expressed satisfaction with not having an overnight ICU admission, and nurses were happy to care for the patients on their oncology unit with just one nursing resource. In phase two, patients who tolerated inpatient desensitization transitioned their subsequent treatments to outpatient. With 12 safe completions of chemotherapy desensitization, the standard of care for chemotherapy desensitization was adopted to the outpatient care space. 

Project Benefits

Overall, the benefits of this project resulted in more than $65,444 in cost savings, with 34 ICU bed days and 23 acute oncology bed days saved. Nurse staffing was optimized, and an overall improvement in patient satisfaction was revealed. This reinforces that patients can receive their cancer treatment despite past infusion reactions and improve their overall survival. This work was disseminated at the 2022 Oncology Nursing Society annual meeting.