(33) Reducing Outpatient CLABSIs for Patients Receiving Blinatumomab One Tier Zero at a Time

Title: Reducing Outpatient CLABSIs for Patients Receiving Blinatumomab One Tier Zero at a Time

Abstract : Basis of Inquiry:
Blinatumomab, a monoclonal antibody immunotherapy, is effective in reducing relapse in B-cell ALL patients (Gupta et al., 2024). As of June 14, 2024, blinatumomab became a standard therapy for B-cell ALL (Center for Drug Evaluation and Research, 2024). The treatment involves two blocks of continuous infusion over 28 days, initially administered in the hospital and then completed at home. However, as patients moved to the outpatient setting, there was a rise in central line-associated bloodstream infections (CLABSIs). From July to October 2024, three CLABSIs occurred among 15 patients who initiated Block 1 in the inpatient Oncology unit at a free-standing pediatric hospital.

Purpose/

Objective:
The purpose of this quality improvement project is to reduce the outpatient CLABSI rate in patients receiving Block 1 blinatumomab by 10% by June 30, 2025.

Methods:
In October 2024, a multidisciplinary team piloted a Blinatumomab Tier Zero (BTZ), a proactive huddle to discuss CLABSI prevention and risk factors at the patient’s bedside. A script was created to standardize discussions on CLABSI prevention, risk factors, and patient/caregiver concerns. A SmartPhrase was developed for documentation in the electronic medical record, giving patients and caregivers access to the information at home. The BTZ participants included the bedside nurse, Safety Quality Specialist, Clinical Nurse Specialist, Vascular Access nurse, Nurse Educator, provider, and patient/caregiver. BTZs occurred in the inpatient oncology unit for all patients initiating Block 1, and Block 2 with a previous CLABSI.

Findings and Outcomes:
From October 2024 to February 2025, 14 BTZs were completed with zero occurrences of CLABSIs, demonstrating a 100% decrease. The BTZ is an effective intervention for preventing outpatient CLABSIs in patients receiving blinatumomab. This method could be adopted for any patient receiving continuous central line intravenous therapy at home.