| Sumario: | Significance & Background: Staff turnover and new leadership contributed to suboptimal conditions when oncologists approached the inpatient team about newly-approved bispecific T-cell engagers (BiTEs). In preparation for the first patient, pharmacy/oncologists created an order set, and the pharmaceutical representative educated nursing about cytokine release syndrome (CRS), a unique BiTE side effect. Initial education was beneficial but could not fully prepare for the reality of firsthand experience. When the patient developed severe hypotension, chills, fever, and hypoxia several hours post-infusion, the oncologist was unreachable, and the emergency response team was unfamiliar with CRS. Early CRS recognition and management can prevent serious or life-threatening complications while maintaining proper treatment guidelines, ultimately impacting treatment effectiveness and patient outcomes. Purpose: Prepare staff to proactively recognize and effectively manage BiTE side effects. Interventions: Learning to manage CRS required intentionality, and processes evolved following the first patient's treatment. The team added hypotension and rash management to the order set. Oncologists instructed patients to hold anti-hypertensive medications before treatment. Pharmacy educated new staff and offered refresher training after lapses in BiTE admissions. Nursing assigned patients to experienced staff with a reduced patient load, allowing for closer monitoring and mentorship opportunities. One patient experienced severe confusion, necessitating education on immune effector cell-associated encephalopathy (ICE) and integration of ICE scoring into the electronic health record. Results: Continuous incremental improvements over two years resulted in 96% (n=52) on-time discharges and increased nurse confidence to anticipate and manage CRS. Each admission had unique learning opportunities, requiring the team to reevaluate processes. Patients expressed high satisfaction with their care and oncologists received fewer calls because staff understood CRS management protocols. One oncologist acknowledged the nurses' competency during a presentation to local oncology nurses. Hospital system colleagues asked for best practices, prompting the team's involvement in creating online training modules. Discussion: A key factor in this journey was integrating multidisciplinary expertise (nursing, pharmacy, physicians, education, information technology) to build institutional capacity for future BiTEs. A layered educational approach using preparatory and just-in-time training, microlearning, and repetition established a foundation for successful staff readiness and knowledge retention for managing complex treatments. This created opportunities for formalizing and standardizing educational strategies into toolkits to share with others. These resources will help accelerate staff readiness, ultimately advancing the science of oncology by expanding patient access to BiTE therapies and improving outcomes.
|
|---|