Background
All chemotherapeutic agents have potential to cause infusion reactions. Our primary objective was to develop a project to assist in appropriate training of nursing staff and incoming fellows for clinic efficiency and patient safety.
Methods
A multi-disciplinary team, including physicians, nurses, and a pharmacist met and following a pre-assessment, a pareto chart was created to determine where to focus our efforts. The results revealed the following areas of concern from most important to least important: utilization of an infusion reaction “kit,” team discussion with staff, infusion reaction simulation, a competency checklist for reactions and “other.” Other responses included: reaction orders in the chart, hands on scenarios, and continued reinforcements. The team resolved to conduct an infusion reaction simulation program to provide an environment to meet many needs of the team, new and experienced. Set in the outpatient infusion center, the program included: a patient/actor, a facilitator, infusion nursing staff, and physicians/fellows. Physicians were invited to participate in the training, but infusion staff were unaware of the program to provide another real life aspect to the simulation; however, both were blinded to the scenario. The pharmacist facilitated the event where the patient actor proceeded to start with a minor infusion reaction that progressed to full anaphylaxis.
Results
Using a Likert scale, a post simulation assessment included 6 questions: 90% of participants felt strongly the exercise increased awareness of the infusion reaction e-kit, 80% felt strongly the exercise was meaningful to their practice, 90% strongly agreed or agreed the scenario simulated a real life situation, also 90% strongly agreed or agreed the program helped them think critically. Finally, 100% of participants strongly agreed or agreed they felt confident in their ability to intervene in the event of a hypersensitivity reaction. Our objectives were achieved: identify the signs and symptoms of a hypersensitivity reaction, utilize the proper intervention in the event of a hypersensitivity reaction. Other outcomes include an updated chemotherapy order consult complete with standing reaction orders in the medical record.
Conclusion
Ultimately, our interdisciplinary simulation concluded with increased awareness, improved confidence, and strengthened collaboration, communication and accountability among our infusion staff and oncology providers