| Sumario: | Significance & Background: Hypersensitivity reactions to cancer treatments range from mild flushing and itching to severe anaphylaxis and, rarely, death. While severe events are uncommon, mild-to-moderate reactions are often underestimated--leading to misclassification, inadequate preparedness, and treatment decisions that risk unnecessary discontinuation or inappropriate rechallenge. A policy review identified key gaps: no grading scale aligned with the National Cancer Institute's CTCAE, absence of symptom-based treatment guidelines, and corticosteroid doses well above those at benchmark institutions. Closing these gaps was essential to standardizing care and ensuring evidence-based, safe, and effective management. Purpose: This quality improvement initiative aimed to develop, implement, and evaluate an evidence-based infusion reaction practice guideline incorporating CTCAE grading, symptom-based treatment recommendations, and optimal steroid dosing, supported by simulation-based education and a performance-tracking dashboard. Interventions: Benchmarking and literature review confirmed CTCAE as the preferred standard and identified best practices for symptom-specific treatment and reduced corticosteroid doses. The updated guideline was approved at the hospital level and rolled out through targeted presentations for physicians, advanced practice providers (APPs), nursing leaders, and front-line staff. To ensure clinical readiness, a collaboration with the affiliated School of Nursing was established to create high-fidelity simulation training. Using the on-site simulation center, mock hypersensitivity reaction scenarios were developed, recorded, and integrated into enduring e-learning modules. These realistic scenarios provided staff with hands-on exposure to reaction recognition, grading, and management in alignment with the new guideline. A customized dashboard was developed in a mapping tool to track process components, including reaction timing, symptoms, CTCAE grading, treatment interventions, and patient outcomes. The dashboard tracks common symptoms, flags delays and care gaps, and provides real-time insights for education, process improvement, and early trend detection. Results: Post-implementation, the rate of antineoplastic rechallenge following an infusion reaction remained stable (69.8% in 2023 vs. 73.1% post-implementation), and the educational module achieved a 100% completion rate. Future evaluations will assess second steroid dose usage, successful re- challenge rates, epinephrine administration, and protocol familiarity at six months post-implementation. Discussion: This project demonstrates the impact of multidisciplinary, interprofessional collaboration in advancing infusion safety. Partnering with the School of Nursing leveraged simulation expertise to bridge academic learning and clinical application, while the mapping-tool dashboard provided actionable insights into reaction trends and system performance. Together, these interventions strengthened clinical practice, improved preparedness, and set a new standard for hypersensitivity reaction management.
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