Time Is Short When Addressing Hypersensitivity Reactions to Chemotherapy
Between administering antineoplastic agents, monitoring patient vitals, and preparing patients for treatment, oncology nurses are required to balance their attention between many intricate tasks. Chief among the division of duties is that oncology nurses closely monitor their patients for hypersensitivity reactions (HSRs) to prescribed agents.
HSRs can strike quickly, within minutes of administration. Time is short, and it’s important to act swiftly to address your patient’s critical needs. Knowing your institution’s procedures and using the right resources when a patient exhibits a HSR can ensure your practice is operating at the highest levels of safety.
Have Protocols in Place
Safely addressing HSRs means being proactive in practice. Creating guidelines and protocols for HSR prevention and management will help to provide a standard of care when emergencies arise. Protocols may specify the frequency with which vital signs should be obtained during drug infusion and parameters to report to providers. They also may dictate medications the provider should include as part of the order set to administer prior to treatment initiation such as acetaminophen, antihistamines, or corticosteroids (https://www.ons.org/store/books/chemotherapy-and-biotherapy-guidelines-and-recommendations-practice-fourth-edition). In the event an HSR occurs, knowing exactly which medications to administer—whether it’s epinephrine, diphenhydramine, a rapid-acting corticosteroid, albuterol, or others—will allow providers to act quickly and confidently for patients displaying symptoms associated with reactions (http://magazine.nursing.jhu.edu/2011/04/acute-hypersensitivity-reactions-what-nurses-need-to-know).
Specific information related to medication usage, when to halt administration, contacting the physician, and how best to recognize adverse reactions are important components to consider (http://magazine.nursing.jhu.edu/2011/04/acute-hypersensitivity-reactions-what-nurses-need-to-know) when developing protocols for HSRs. Working together with your institution, colleagues, and interdisciplinary team members can help ensure patient needs are being addressed.
Easy Access to Necessary Resources
Oncology nurses need to have easy access to medications and resources when addressing reactions to antineoplastics. Making certain that crash carts and medication dispensing systems (http://theoncologist.alphamedpress.org/content/12/5/601.long) are equipped with the proper medication and dosage is key to providing efficient care when a reaction takes place.
Some agents, such as monoclonal antibodies, have an increased likelihood of reactions with initial doses, whereas with others such as carboplatin, the risk increases with each subsequent infusion (https://www.ons.org/store/books/chemotherapy-and-biotherapy-guidelines-and-recommendations-practice-fourth-edition). Recognizing these agents and having clear procedures in place can reduce the potential risk to patients. In some cases, understanding which medications need to be administered prior to infusion can help alleviate potential reactions.
Keep Yourself Up to Date With CNE
Continuing education opportunities can be a great way to understand the latest tactics and procedures for addressing HSRs. ONS members Brenda Shelton, MSN, RN, CCRN, AOCN®, and Jane Shivnan, MScN, RN, AOCN®, have authored a free CNE activity about what nurses need to know to manage HSRs.
ONS’s book Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (https://www.ons.org/store/books/chemotherapy-and-biotherapy-guidelines-and-recommendations-practice-fourth-edition) has further educational information regarding the management of HSRs. Also, consider refreshing your HSR knowledge through the ONS/ONCC Chemotherapy Biotherapy Certificate course or the ONS Chemotherapy Biotherapy: Fundamentals of Administration course. Both courses offer in depth analysis and discussions for oncology nurses managing patients with HSRs to treatment agents.