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P576. A nurse-led one-hour infusion protocol of infliximab is safe and improves infusion service efficiency

R. D'Incà, A. Lupi, A. Buda, A. Favarin, M. Martinato, G.C. Sturniolo, V. Zanotto, Padua, Surgical, Gastroenterological and Oncological Sciences, Padua, Italy

Background

The use of biological agents requires additional training for administration, monitoring and screening procedures by the nurses. The drug is administered over a 2-hour period with one further hour of clinical observation. The increasing use of infliximab for inflammatory bowel disease treatment impacts heavily because of the costs and the limited hospital resources. Efficacy, safety and patient satisfaction of a nurse-led accelerated infusion program of infliximab was tested.

Methods

Drug pharmacology, dosing and scheduled treatment strategies were illustrated and nurses were trained to recognize and treat potential side effects. A protocol was developed to monitor variations in vital signs, body temperature and any other adverse effect. Eligibility for the 1-hour protocol was verified in each patient, starting from the fourth infusion, according to the presence/absence of previous infusion-related reactions. Demographic information and disease diagnosis, disease extent and behaviour, number of infliximab infusions and concomitant therapies were recorded. 186 patients were eligible and 182 entered the program. Four patients refused to enter the nurse-led procedure. All infusion reactions and severity were recorded as well as the number of physician's calls and changes in infusion protocol, including stopping infliximab. A questionnaire for testing patient's satisfaction was developed and handed out to patients as they attended their appointment.

Results

Between January 2012 and October 2013, 2048 infusions were administered to 182 patients (mean 11.25 infusions, range 4–23). 1502 infusions were carried out with the nurse supervision in one-hour. The physician performed 124 visits for suspect contraindications to infusion emerging from the nurse's assessment. A total of 26 adverse events occurred in 12 patients, five severe reactions required stopping infusion. 91% of the patients were satisfied with the 1-hour nurse led-program and 51.4% appreciated the spare time. Only 11% of the patients felt insecure with the nurse-led protocol and would have preferred to see the physician at each infusion. The program allowed to double the number of patients treated in the service while sparing physician's time and decreasing nurse workload (0.5 FTE: full time equivalent/week).

Conclusion

Our nurse-led accelerated (1-hour) Infliximab infusion programme has proved to be safe and increased the efficiency of the service with more patients treated and appropriate staff use. In addition several tangible benefits have been achieved: patients were satisfied with the nurse-led care and for their spare time, nurses felt more gratified with their work and actively involvement in the patient's care.