BRINGING BITES BEYOND THE BEDSIDE IMPLEMENTING SAFE OUTPATIENT STEP-UP DOSING FOR MULTIPLE MYELOMA.
Significance & Background: Bispecific T-cell Engagers (BiTEs) are immunotherapies that link T-cells to specific cancers. Two primary adverse events associated with BiTEs are cytokine release syndrome (CRS) and neurotoxicity. Due to these risks, package inserts recommend inpatient monitoring for 48 h...
| Publicado en: | Oncology Nursing Forum Vol. 53; no. 2; pp. 106 - 108 |
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| Autores principales: | , , |
| Formato: | Journal Article |
| Publicado: |
Oncology Nursing Society
Mar2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194211303&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194211303 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0190535X 4F0 jtl: Oncology Nursing Forum issn: 0190535X maglogo: N pubinfo: dt: Mar2026 vid: 53 iid: 2 pid: 12496 pub: Oncology Nursing Society place: Pittsburgh, Pennsylvania artinfo: ui: 194211303 10.1188/26.ONF.e26535271 194211303 ppf: 106 ppct: 2 formats: fmt: @attributes: type: P tig: atl: BRINGING BITES BEYOND THE BEDSIDE IMPLEMENTING SAFE OUTPATIENT STEP-UP DOSING FOR MULTIPLE MYELOMA. aug: au: Fleishman, Sarit Milliron, Todd Swisher, Marie affil: MSN, RN, OCN, Greenebaum Comprehensive Cancer Center at University of Maryland Medical Center, Baltimore, MD sug: ab: Significance & Background: Bispecific T-cell Engagers (BiTEs) are immunotherapies that link T-cells to specific cancers. Two primary adverse events associated with BiTEs are cytokine release syndrome (CRS) and neurotoxicity. Due to these risks, package inserts recommend inpatient monitoring for 48 hours after each step-up dose. However, limited inpatient bed avail-ability at an NCI-designated Comprehensive Cancer Center caused delays in patient treatment, prompting interest in transitioning step-up dosing to the out-patient setting. Purpose: The purpose of the project was to develop a standardized multidisciplinary outpatient process for step-up dosing of two BiTE therapies used in multiple myeloma while ensuring patient safety and treatment compliance. Interventions: A plan-do-study-act approach guided the initiative. Between February and April 2025, nursing, provider, and pharmacy stakeholders met to determine patient eligibility criteria, pre-treatment requirements, nurse and provider responsibilities, patient education, and follow-up procedures. Patient education materials covering at-home care, side effect monitoring and management, and caregiver responsibilities were re-viewed and approved by the Patient Education Committee. Patients were instructed to check their temperature every eight hours and contact the Patient Assistance Line (PAL) if symptoms of CRS or neurotoxicity developed. Patients were also sent home with a dose of dexamethasone to take for symptoms if instructed by the PAL provider. Documentation templates were built to ensure that education is in the After-Visit Summary and to standardize nursing care notes. Once approved by an oncology safety commit-tee, the process was disseminated through staff meetings and huddles. Results: All outpatient nurses were trained before Go-Live. Tipsheets about the process were created for the unit. From April to July 2025, seven eligible patients received their step-up BiTE therapy in the outpatient setting. Of these patients, three experienced CRS, with one requiring hospitalization. Discussion: With increasing utilization of BiTE therapies, timely and safe access is important. Implementing a standardized outpatient step-up dosing process reduced delays caused by inpatient bed shortages and allowed safe at-home monitoring. This shift not only enabled patients to receive therapy without unnecessary admissions but also freed inpatient bed capacity for other cancer patients needing hospitalization for treatments. Next steps include ongoing evaluation of patient eligibility, reinforcing nursing education on the use of standardized documentation templates, and expanding outpatient step-up dosing to additional BiTE therapies. This process demonstrates that BiTE patients can be safely and effectively managed in the outpatient setting. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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