JOPHON NCPD (2024 Sept/Oct) A Quality Approach to Blinatumomab Delivery-JOPHON NCPD (2024 Sept/Oct) A Quality Approach to Blinatumomab Delivery

JOPHON NCPD (2024 Sept/Oct) A Quality Approach to Blinatumomab Delivery

Pdf Summary

This Children’s Oncology Group qualitative study explored clinician perspectives on safely administering blinatumomab—a bispecific T-cell engager increasingly used for pediatric relapsed B-lineage acute lymphoblastic leukemia—across inpatient, outpatient, and home settings. Because blinatumomab is delivered as a continuous 28-day IV infusion and may transition to home after initial monitoring, institutions face distinct logistical and safety challenges that are not fully addressed by protocols.<br /><br />Thirteen clinicians from U.S. and Canadian pediatric oncology centers (primarily experienced nurses and nurse practitioners) participated in semistructured interviews. Using constant comparative analysis, investigators identified an overarching theme: “A quality approach to blinatumomab delivery in pediatric oncology.” Across diverse institutions, clinicians described a common improvement-oriented cycle resembling quality improvement processes: planning care delivery, delivering care, creating/revising processes, communicating, and reflecting/evaluating.<br /><br />In the planning phase, teams determined whether home infusion was feasible, secured infusion pumps and supplies (often through rentals, borrowing, or institutional purchase), and developed robust education for both staff and families—often requiring refreshers due to infrequent use and staff turnover. During care delivery, multidisciplinary coordination was essential, including pharmacy, nursing, physicians, emergency departments, intensive care units, and procedural areas. Challenges included line dislodgement or leaks in active children, hygiene limitations during prolonged access, lack of home health support, electronic medical record documentation barriers for home infusions, and mismatched inpatient vs outpatient policies.<br /><br />Institutions emphasized building and continually revising workflows for pump use, bag changes, venous access, and emergency processes (including “fast pass” return pathways and 24/7 troubleshooting). Communication strategies—emails, binders, visual “do not flush” labels, and interdepartmental alerts—were central to safety.<br /><br />Participants recommended more standardized nursing-focused guidance, shared resources (tip sheets, family education templates), hands-on training, and stronger inter-site networking so centers do not “reinvent the wheel.” The study concludes that nurses are pivotal in developing systems that support safe immunotherapy delivery while protecting quality of life, especially when therapy extends into the home.

Keywords

blinatumomab

pediatric relapsed B-lineage acute lymphoblastic leukemia

bispecific T-cell engager

continuous 28-day IV infusion

home infusion safety

inpatient outpatient home care transition

nursing perspectives

quality improvement workflows

infusion pump and bag change protocols

multidisciplinary coordination and communication