(22) A multidisciplinary approach to implementing and evolving new standard of care with Blinatumomab

Title: A multidisciplinary approach to implementing and evolving a new standard of care with Blinatumomab

Abstract : Blinatumomab was recently adopted as the SOC for patients with B-Cell ALL. As its use expanded, an influx of patients led to challenges with drug administration, including unintentional disconnects, premature infusion terminations, issues in ordering and preparing new bags, issues with carrier fluids, and gaps in staff knowledge of premedication and observation protocols. These concerns presented an opportunity to improve the administration process and enhance patient care.

The purpose of this quality improvement project was to address and resolve the challenges related to blinatumomab administration as it became the standard of care. The objective was to reduce unintentional disconnections, improve infusion continuity, streamline medication preparation, and enhance the patient experience. The hypothesis was that systematic interventions, including multidisciplinary collaboration and process improvements, would lead to better outcomes and reduce the frequency of issues associated with administration.

A multidisciplinary workgroup, including physicians, nurse practitioners, registered nurses, and pharmacists, was formed to review trends in reported events and gather feedback from frontline staff. The group focused on improving the administration process, enhancing staff education, and addressing logistical issues, such as premedication and infusion-related concerns. Key interventions included eliminating carrier fluids, adjusting scheduling to minimize infusion pauses, adjusting premedication and observations, and providing targeted staff training on administration and troubleshooting. Data on infusion disconnects, steroid use, and patient experience were collected and analyzed before and after the intervention.

Post-intervention data demonstrated a significant reduction in unintentional disconnections and premature infusion terminations. There was a notable improvement in patient experience, with fewer disruptions, improved experience in school attendance and reducing the need for steroid administration due to prolonged infusion pauses. Scheduling adjustments minimized infusion interruptions, leading to more efficient and continuous drug administration. These improvements resulted in better patient outcomes and a smoother, more efficient delivery of care for those receiving blinatumomab.