Use of a Pharmacy Protocol to Convert Standard Rituximab Infusions to Rapid Infusion Shortens Outpatient Infusion Clinic Visits

Abstract

To evaluate the impact of a pharmacy protocol that converts standard rituximab infusions to a rapid 90-minute infusion on the duration of outpatient infusion center clinic visits. Prospective interventional study. Outpatient infusion clinic at an academic medical center. Sixty-four adults who received at least one rituximab infusion that was eligible for conversion to rapid infusion between August 2010 and July 2011 and who did not receive concurrent chemotherapy or colony-stimulating agents during the same clinic visit. Of the 64 patients, 37 received the rapid infusion (intervention cohort); 27 received the nonrapid infusion (control cohort). Using a hospital-approved protocol, pharmacists converted rituximab infusions that met eligibility criteria (noninitial rituximab infusion, rituximab given in the previous 90days, age 18yrs or older, dose 375mg/m(2) or less per infusion, dose 1000mg or less per infusion, and no history of a grade 3 or higher reaction) to a rapid 90-minute infusion. The durations of rituximab infusion time and clinic visit time were evaluated and compared between the intervention cohort and the control cohort. Use of the pharmacy protocol to convert standard rituximab infusion to rapid rituximab infusion reduced infusion time by 110.5minutes/infusion (median 94.5min [interquartile range (IQR) 90-105min] for rapid infusion vs 205min [IQR 138-263min] for nonrapid infusion; p<0.001) and reduced clinic visit time by 92minutes/outpatient encounter (median 233min [IQR 208-277] min for rapid infusion vs 325min [IQR 275-415min] for nonrapid infusion; p<0.001). This resulted in a reduction of the duration of outpatient clinic visits by an estimated 255-299hours in 1year. Use of a pharmacist protocol that converted standard rituximab infusions to a rapid 90-minute infusion decreased the duration of outpatient infusion clinic visits for rituximab infusion.