| Sumario: | Significance & Background: Nursing workload in hemato-oncology outpatient centers (HOOC) remains insufficiently documented. Retrospective analyses of prescribing software datasets are limited due to lack of real-time documentation and missing records of mandatory nursing tasks such as line flushing, responding to pump alarms, addressing patient needs and managing adverse events. These aspects contribute to overlooked nursing workload and inefficient time management. Purpose: Despite regional variations in infusion setups, manual interventions are universally required. This study aims to prospectively quantify nursing workload in a German HOOC, with the intention of expanding the analysis to an American setting as an international collaborative project. The purpose is to provide evidence for observable and hidden nursing tasks influencing patient care, therapy duration, and workflow efficiency. This study enables cross-national comparison and evaluation of potential for optimization. Interventions: A prospective observational study was conducted in a German HOOC, treating approx. 60 cancer patients daily with infusion therapy. Standardized antineoplastic therapy protocols (TP) administered via infusion pumps were included (excluding clinical trials) to ensure comparability across patients and settings. Study specific QR code scanners were used to record time-stamped infusion interruptions and nursing interventions. An independent research assistant re-corded all nursing activities before, during and after therapy in real time. Interventions were categorized by type, sources of interruptions, and clinical relevance. Results: Preliminary data from 83 patients show that average therapy sessions were almost 1h 35min longer than the expected TP. For simpler TP, such as Pembrolizumab the session duration exceeds the TP by more than 45mm. For more complex TP, such as FOLFIRI+Bevacizumab the TP is exceeded by 2h 13mm. The common disruptions were found to be manual pump adjustments, flow related disruptions, and patient requests. Additional delays were associated with therapy approval, drug preparation and transport happening before administration. The average number of nursing interventions is more than six times per therapy session. Discussion: This prospective study highlights the persistent challenges faced in HOOC. These insights can help optimize staffing and workflow, enhance job satisfaction, and improve patient care. Next steps include data analysis and prospective process observation at large U.S. cancer centers and comparison with German data. By engaging in collaborative learning, nurses and pharmacists can play an active role in improving the safety and efficiency of processes in both countries.
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