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Introduction Monoclonal antibody drugs are widely used anti-cancer therapies in the oncology outpatient setting. Increasing demand for outpatient cancer care necessitates exploration of improvements in efficiency. Limited literature has investigated the impacts of bolusing intravenous administration sets with monoclonal antibodies on chair time and associated cost. We hypothesised that bolusing IV administration sets with monoclonal antibodies would be a safe and efficient method to reduce chair time and associated cost in the oncology outpatient setting. Objectives/Aims Primary objective: To evaluate the impact on chair time and associated cost of bolusing intravenous administration sets with prescribed monoclonal antibodies, compared to a compatible fluid. A secondary objective was to assess the incidence of hypersensitivity reactions associated with this practice. Description/Methodology A randomised controlled trial (n=128), with a two-arm design (monoclonal antibody bolus versus priming with a compatible fluid i.e., 0.9% sodium chloride) at a major, quaternary hospital in metropolitan Brisbane, Australia. Included monoclonal antibodies were daratumumab, obinutuzumab, pembrolizumab and nivolumab. Cost per minute of chair time were calculated from the National Efficient Price Determination 2023 for 'chemotherapy -- treatment'. Results/Outcomes From July 2021 to January 2022, 52 patients were recruited, representing 128 episodes of care. There was a statistically significant reduction in chair time for obinutuzumab (16-minute reduction; P=0.032), pembrolizumab (7-minute reduction; P=<0.001) and nivolumab (7-minute reduction; P=<0.001) compared to priming with a compatible fluid. This led to a cost saving of $46.40, $20.30, and $20.30 (AUD) per infusion respectively, for these three monoclonal antibodies. There was no statistically significant difference in frequency of hypersensitivity reactions between study arms. Conclusion Findings suggest that bolusing IV administration sets with a prescribed monoclonal antibody drug could reduce chair time and cost in busy oncology outpatient settings. A powered study to assess the incidence of hypersensitivity reactions related to this practice is recommended. [ABSTRACT FROM AUTHOR]

Introduction Brachytherapy is a targeted form of radiation treatment that requires specialist, multidisciplinary management. Despite this, there is currently no standardised clinical pathway for the management of gynaecological and prostate brachytherapy. Aims/Objectives The aim of this study was to develop a comprehensive, standardised clinical pathway for the management of brachytherapy patients that can be utilised by multidisciplinary staff to improve patient safety. Methodology A multi-phase, iterative process was undertaken. Phase 1 involved a clinical review of incidents and adverse events over a five year period. Phase 2 encompassed a representative survey of nursing staff from the radiation oncology, medical oncology, and haematology units where the brachytherapy beds are located. The survey assessed the staff's current level of knowledge and confidence in the management of brachytherapy. Phase 3 utilised the findings of the previous phases to develop a clinical pathway. Results Phase 1 identified forty (n=40) brachytherapy incidents reported between 2018-2023. The most common incidents were clinical process error (40%), medication error (30%), skin integrity (13%) and miscommunication (8%). Thirty-five (n=35/114) nurses from inpatient and outpatient settings completed the Phase 2 survey, representing 31% of the cancer nursing workforce of a large, tertiary hospital. Findings displayed that 57% of participants lacked confidence in managing patient controlled analgesia and 54% lacked confidence in epidural removal. Less than 50% were aware of the brachytherapy repositioning time frames and over 50% identified the incorrect escalation pathway for non-urgent care. 100% of participants agreed that a clinical pathway be beneficial. This led to the development of a multidisciplinary clinical pathway, which incorporated pre-, peri- and post- assessment instructions and prompts related to identified common clinical incidents. Conclusions Results display that there is a critical need for a standardised clinical pathway for the management of brachytherapy. The next steps will be to implement and evaluate this pathway. [ABSTRACT FROM AUTHOR]