Meeting Abstract

JL506. Dedicated Advanced Practice Provider in an Outpatient Oncology Infusion Center

Christina Z. Page, MSN, RN, AOCNP®, AGPCNP-BC, and Delores P. McNair, MHA; Duke Cancer Institute, Durham, North Carolina

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Abstracts From 
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017

The posters for the abstracts below can be found at:

Background: Adverse drug reactions are a part of infusion treatment in oncology despite the best clinical efforts. At a community-based cancer center, an estimated 50 to 70 patients per day receive chemotherapy, immunotherapy, or non-oncology infusion. The incidence of chemotherapy-related hypersensitivity is about 5% (Gobel, 2005). The incidence of hypersensitivity reaction with immunotherapy can be higher than 15% with first dose of some monoclonal antibodies (Lenz, 2007). Adverse drug reactions (ADRs) have sizeable clinical costs (Sultana, Cutroneo, & Trifiro, 2013). A previous study by the Duke Raleigh Cancer Center demonstrated that the addition of an advanced practice provider (APP) in the outpatient infusion therapy center offered benefits of decreasing escalation of ADRs and the number of severe allergic reactions (Young, Dill, Fesko, & MacDiarmada, 2016). Leadership added a dedicated APP to the infusion room and a study was initiated to evaluate the impact and value added to the multidisciplinary groups who contribute to care of patients receiving outpatient infusions.

Methods: We initiated a 12-statement survey evaluated on a five-point Likert scale with two open-ended questions. Seventy-six members were surveyed within the cancer center to include infusion and clinic nurses, doctors, APPs, administrators, pharmacy and others. Data is being collected on the severity of ADRs.

Results: Survey response rate was 38%. Several survey questions showed 100% of respondents either agreed or strongly agreed to the following statements: the dedicated infusion APP decreases the level of stress and anxiety among patients and nursing staff during an acute infusion reaction, promotes patient safety, responds in a timely manner, manages ADRs appropriately, and is a positive presence in the infusion area. Most agreed that the APP minimized disruption of clinic flow. The survey encompassed a 5-month period in which approximately 45 infusion-related ADRs were identified with only 4 resulting in escalation of care to the Emergency Room.

Conclusions: Data demonstrates the positive impact and value of a dedicated infusion APP. Improvements in the management of ADRs offers benefits to the patient and likely cost savings to the institution. Limitations to this study include response rate, lack of comparative surveys, and limited data collection sources for ADRs. Recommendations: Additional data needed to measure the impact on patient safety, costs and sustainability of the role in the ever-changing arena of oncology treatment, as well as physician attitudes toward APP roles. Exploration of dedicated APPs in the infusion room by other institutions to evaluate the benefits.

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