A Quality Improvement DNP Project to Increase Adherence to an Adult Hypersensitivity Protocol in the Non-Hospital Based Infusion Center

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Elizabeth Hill Joran (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site: http://library.uncg.edu/
Lori Lupe

Abstract: Background: The use of therapeutic intravenous immunomodulatory agents in the past decade has increased incrementally in the Infusion Center setting. Similarly, adverse drug events (ADE) related to infusion-related reactions (IRR) are rising. This can lead to adverse patient outcomes, such as increased morbidity, reduction in treatment modality and efficacy, and the possible need for escalation in care management. The burden of costs associated with ADE exceeds $30-130 billion dollars per annum in the United States. While IRRs comprise only a fraction of ADE events, efforts to decrease their occurrence and effective clinical management should be made in all Infusion Centers. Purpose: This DNP student project aims to ascertain whether a concentrated educational effort amongst Infusion staff increases the use and adherence to an established Adult Hypersensitivity protocol (AHP), thereby optimizing patient care outcomes.Methods: A five-question survey regarding the AHP was administered to staff prior to the multidimensional education intervention to determine baseline knowledge. Similarly, chart audits were conducted to deduct the staff’s current use and adherence to the AHP in the Infusion Center during an ADR. Using the Plan-Study-Do-Act translational framework, a multimodal educational intervention was conducted that entailed a concentrated recorded presentation regarding the AHP, the use of visual cues at the bedside, and one on one staff education and real-time verbal feedback. A three-month postimplementation chart review and repeat survey were conducted to determine whether increased protocol knowledge, use and adherence by staff had been accomplished. Results: Protocol use and adherence increased percentages. However, it was determined to be statistically non-significant. The data represent inconclusive conclusions based on project implementation inference errors, sample power, and effect size. This Recommendations and Conclusion: The unexpected finding that staff use and adherence to the AHP protocol did not increase following a concentrated educational effort represents the need for further research and exploration in this clinical area. Future recommendations include a site-specific review of the protocol and a more comprehensive institutional effort to assess protocol use and adherence amongst all related Infusion Centers.

Additional Information

Language: English
Date: 2023
Adverse drug reaction (ADR), Anaphylaxis, Clinical practice guidelines (CPG), Hypersensitivity reaction (HSR), Infusion-related reaction (IRR), Quality improvement (QI)

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