Use of a Pharmacy Protocol to Convert Standard Rituximab Infusions to Rapid Infusion Shortens Outpatient Infusion Clinic Visits

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Abstract

Study Objective

To evaluate the impact of a pharmacy protocol that converts standard rituximab infusions to a rapid 90-minute infusion on the duration of outpatient infusion center clinic visits.

Design

Prospective interventional study.

Setting

Outpatient infusion clinic at an academic medical center.

Patients

Sixty-four adults who received at least one rituximab infusion that was eligible for conversion to rapid infusion between August 2010 and July 2011 and who did not receive concurrent chemotherapy or colony-stimulating agents during the same clinic visit. Of the 64 patients, 37 received the rapid infusion (intervention cohort); 27 received the nonrapid infusion (control cohort).

Intervention

Using a hospital-approved protocol, pharmacists converted rituximab infusions that met eligibility criteria (noninitial rituximab infusion, rituximab given in the previous 90 days, age 18 yrs or older, dose 375 mg/m2 or less per infusion, dose 1000 mg or less per infusion, and no history of a grade 3 or higher reaction) to a rapid 90-minute infusion.

Measurements and Main Results

The durations of rituximab infusion time and clinic visit time were evaluated and compared between the intervention cohort and the control cohort. Use of the pharmacy protocol to convert standard rituximab infusion to rapid rituximab infusion reduced infusion time by 110.5 minutes/infusion (median 94.5 min [interquartile range (IQR) 90–105 min] for rapid infusion vs 205 min [IQR 138–263 min] for nonrapid infusion; p<0.001) and reduced clinic visit time by 92 minutes/outpatient encounter (median 233 min [IQR 208–277] min for rapid infusion vs 325 min [IQR 275–415 min] for nonrapid infusion; p<0.001). This resulted in a reduction of the duration of outpatient clinic visits by an estimated 255–299 hours in 1 year.

Conclusion

Use of a pharmacist protocol that converted standard rituximab infusions to a rapid 90-minute infusion decreased the duration of outpatient infusion clinic visits for rituximab infusion.

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