(39) It’s the Final Countdown: Tracking Methotrexate Timing

Title: It’s the Final Countdown: Tracking Methotrexate Timing

Abstract : Basis of Inquiry:
One pediatric hematology oncology inpatient unit had seen an increase in high dose methotrexate (HDMTX) infusion times exceeding recommended timing. The average infusion time for HDMTX infusions was 24 hours and 47 minutes, which exceeds the 24-hour expected infusion time.
Purpose/

Objective:
The purpose of this quality improvement project was to optimize workflow to ensure the infusion was completed within 24 hours.

Methods:
This initiative took place in a Midwest Children’s Hospital on a pediatric hematology oncology inpatient unit, using rapid cycle PDSA (Plan, Do, Study, Act). During PDSA cycle one, targeted nursing education and methotrexate tracker were implemented. The education included didactic and hands on skills, reviewing rapid priming, releasing and retiming labs in the electronic medical record (EMR), key nursing assessment and interventions, and the use of the HDMTX tracker. The tracker was developed to be used by our nurses to track the progress of the infusion including start times, pump volume to be infused (VTBI) checks at hours 12, 16, 20, and 22, and to help assess any barriers to the infusion completing on time. Cycle one PDSA did not impact HDMTX infusion times. During cycle two PDSA, the use of a hanging scale was implemented to ensure the volume would complete within 24 hours, which did not impact infusion times. During the final PDSA cycle, teams focused on estimating VTBI at hour 20, and adjusted HDMTX infusion rates to finish on time.
Findings or Outcomes:
Following the implementation of this project, the average HDMTX infusion is now 24 hours and 32 minutes, which showed improvement by 15 minutes. The use of rapid cycle PDSA supports quick improvement in troublesome processes.