Background: The utilization of rituximab for a variety of different indications has historically been associated with logistical challenges related to time and labor. Institutions across the country have implemented protocols to shorten the infusion time of rituximab in order to help alleviate these challenges. The purpose of this study was to support the safe implementation of a 90-minute rapid infusion protocol for rituximab at the Richard L. Roudebush VA Medical Center and improve staff perception regarding similar initiatives in the future with other therapies.
Methods: Proactive measures were taken to educate physicians, pharmacists, and nurses about their role in the implementation of the protocol. A weekly report of patients receiving rituximab was generated from November 1st, 2018 to April 1st, 2019. Patients were then screened for future eligibility for rapid infusions of the drug based on prespecified criteria and providers were notified regarding potential candidates. After patients received their rapid infusions, a retrospective chart review was performed to evaluate patient tolerability and assess for any safety concerns.
Data Analysis : The primary endpoint for this study was the incidence of grade 3 and 4 infusion related reactions associated with the rapid infusions of rituximab based on criteria from CTCAE version 5.0. Secondary endpoints were savings in infusion clinic chair time and the proportion of patients experiencing a grade 3 or 4 infusion related reaction to the rapid infusion that received proper treatment according to the institution’s hypersensitivity protocol. All endpoints were analyzed using descriptive statistics.
Results: During the study period, 11 patients received a total of 24 rapid infusions of rituximab. One out of 24 infusions (4.17%) resulted in a grade 3 infusion related reaction. This patient was treated appropriately by nurses according to the institution’s hypersensitivity protocol. The average savings in infusion clinic chair time by rapid infusions was 39.3 minutes.
Conclusion: This study proved that a rapid infusion protocol for rituximab can be successfully implemented at the Richard L. Roudebush VA Medical Center. The proactive measures utilized to implement the protocol improved provider prescribing rates and nursing satisfaction. Future plans involve implementing a rapid infusion protocol for daratumumab.
