(68) Let Them Stay Home!

Title: Developing a protocol for efficient Blinatumomab therapy at home

Abstract : Basis of Inquiry
Pediatric oncology patients may undergo 28-day continuous infusion blinatumomab cycles, raising the question of how to best manage care during this time. Due to limited collaboration among institutions, patient experiences are inconsistent. Admitting for the entire cycle can burden patients, families, and the healthcare system. Developing a safe and effective outpatient policy and procedure could reduce these challenges.
Purpose and Objectives
The purpose of this project was to develop a policy for standardizing blinatumomab administration in both the inpatient and outpatient settings, addressing relevant barriers. The objective was to enable patients to remain home for most of the cycle, with a built-in workflow involving the inpatient, outpatient and emergency departments.
Methods
Our institution contracted with a third-party infusion pump company to rent patient-specific CADD pumps. Families received one-on-one education for home-pump use, along with resources for troubleshooting. After discharge, the patient was given outpatient appointments for twice weekly bag changes and lab draws. A policy was developed to address issues such as line breaks after hours, identified the pediatric hospital pharmacy to store emergency back-up bags, and the inpatient unit to store additional pumps. Education was also provided to emergency department staff. If a patient presented to the ED, the inpatient oncology unit would be notified to send down a nurse to assess and troubleshoot the issue in real-time.
Findings
After implementation, families expressed no concerns upon discharge once they were familiar with the home infusion pump. Emergency department staff appreciated having an expert available for consultation. Patients, families, and the healthcare teams reported a reduced burden transitioning from prolonged admissions to twice-weekly outpatient visits.