| Sumario: | The uncanny characteristic of cancer has made the disease more complicated over the years, demanding the medical field to seek innovative treatment strategies continuously. The Chimeric Antigen Receptor bearing T-cell (CAR T) has emerged as the new paradigm of cancer immunotherapy to tackle cancer's resistance mechanisms in some hematologic malignancies that have relapsed or are unresponsive to treatments. The infusion of CAR T initially began in the inpatient settings and is now evolving into the outpatient units, after gaining remarkable outcomes. The purpose of this project was to develop an educational program for ambulatory nurses to ensure the success of providing this treatment in the outpatient center. A literature review was conducted, and studies show that an infrastructure must be in place because of the complex care requirements and significant neurotoxicities and side effects of CAR T treatments. In January 2019, the ATC leadership team built a robust outpatient educational program to deliver approved standard and phase 1 CAR T treatments and embedded them into existing workflow processes in a unit that also provides care for stem cell patients. Solidifying the nursing education was crucial for this project, and competencies included completing CAR T modules, hands-on training and check-off on the inpatient lymphoma/myeloma unit, and in-service by research investigators. Thorough assessment, early detection of the toxicities, and documentation in the electronic medical record (EMR) using the standardized assessment tools are integral to prompt and safe care for these patients. Concurrent with the training, an extensive collaboration with the medical teams, apheresis department, research investigators cell lab, research lab, pharmacy, and scheduling team was completed. Twenty-one nurses achieved CAR T competency, and in March of 2019, the ATC began to provide care for CAR T patients by administering lymphodepleting chemotherapy and doing post CAR T assessments. The CAR T infusions began in December 2019 and has successfully infused seventy CAR T cells. Fifty eight of those were phase 1, three were T-cell for COVID-19 patients, and nine were standard CAR T up to date. Although CAR T therapies may be complex and have varying information and monitoring parameters, these advances are changing the current and future cancer care environment, leading to significant improvements in patient care and outcomes.
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