| Sumario: | Significance & Background: A gap analysis was completed at a National Cancer Institute designated comprehensive cancer center, across ambulatory and inpatient, to identify inconsistencies in practice and protocols varying from the updates to the Oncology Nursing Society (ONS) guidelines for hypersensitivity reaction (HSR) in 2023. The analysis revealed that Registered Nurses (RNs) felt uncomfortable initiating oxygen therapy during HSR without a physician order. RNs were delayed in identifying anaphylaxis criteria during HSR, causing a delay in administration of epinephrine, leading to prolonged exacerbation of symptoms. RNs were administering corticosteroids when contraindicated during HSR, such as with certain immunotherapies. Purpose: Implement and disseminate evidence-based standardization of care to optimize patient safety considerations, enhance clinical response, improve RN confidence to assess and manage HSRs in alignment with ONS Infusion-Related Toxicity Algorithm. Interventions: An interdisciplinary working group was developed to strategize implementation of the new guidelines. Outcomes of the gap analysis were reviewed. The current HSR algorithm and worksheets were revised. Updates included visual restructuring, standardized initial interventions, addition of an as needed order for oxygen, rapid assessment criteria for anaphylaxis and a conditional order for corticosteroid administration to be utilized with provider discretion. Extended education over six weeks prior to implementation included a multi-level approach for optimization including nursing, pharmacy, providers and patients to approve early adoption and adherence to the changes. Results: A proactive extended education plan fostered successful implementation in August 2025. The interdisciplinary team reported increased confidence, communication pathways, timeliness and accuracy in the assessment and management of HSR with the updated institutional protocols. This included earlier identification of anaphylaxis, administration of epinephrine, use of oxygen and expedited escalation to the emergency response team. Hard stop functionalities within the electronic medical record resulted in immediate adoption of conditional corticosteroid administration, eliminating the risk of the RN administering it when it is contraindicated. Long term, we anticipate seeing improved clinical responses with HSRs and improved immunotherapy efficacy. Discussion: Early adoption and education regarding new ONS guidelines by aligning with institutional protocols can improve patient safety and close the gap from bench to bedside. RNs are pivotal in application of HSR assessment and management, partnering with the interdisciplinary team to enhance real-time decision making.
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