| Sumario: | Significance & Background: Traditional 3-bag desensitization protocols are commonly used for agents associated with hypersensitivity reactions (HSRs). These protocols involve a 12-step titration across three bags: 1% of the dose over four steps, 10% over another four, and the remaining 89% over the final four. While standard, this method is complex and labor-intensive for both nursing and pharmacy teams, has drug waste in all three bags, is prone to error, challenges occur if pump technology does not accommodate extremely slow rates, and still results in a notable rate of HSRs. Purpose: This project explores whether a single-bag desensitization protocol--informed by current literature and utilizing rate adjustments instead of serial dilutions--can safely and effectively reduce hypersensitivity reactions (HSRs), improve treatment completion rates, and streamline workflows for nursing and pharmacy teams. Interventions: Minnesota Oncology pharmacists created a single-bag desensitization protocol that applied to Carboplatin, Cisplatin, Oxaliplatin, Paclitaxel, and Docetaxel. A reference table guides appropriate dilution volumes based on ordered doses. The protocol included a 7-step titration: four 15-minute intervals followed by three 30-minute intervals. The remaining 84.18% of the infusion is administered in the final step. Results: A retrospective chart review was conducted from October 2022 to September 2025. Among 32 patients treated with the 3-bag protocol (Oct 2022-Sept 2023), 40.6% experienced HSRs. In contrast, of the 61 patients treated with the single-bag protocol (Oct 2023-Sept 2025), only 32.7% experienced reactions. Furthermore, 55% of patients who reacted to the single-bag protocol were successfully rechallenged and completed treatment, compared to 30.8% in the 3-bag group. Discussion: Single bag desensitization has improved RN and admixture technician workflow by reducing the complexity of the admixture process. It has reduced potential for error by following a 7-step titration vs. a 12-step titration and has reduced chair time from approximately 5.75 hours to 4.1 hours, when completed without pausing for HSR. Nurses report that reactions are less frequent and less severe--an observation supported by retrospective data.
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