Moving Mobilization Chemotherapy From the Inpatient to the Outpatient Setting

Significance & Background:  Appropriate use of resources and reducing costs are crucial goals in today’s healthcare environment.  Our busy inpatient unit with a full census was leading to the overnight stays for mobilization chemotherapy taking lower priority than admissions for transplant and readmissions. Mobilization chemotherapy patients were being postponed and rescheduled to later dates and times due to a lack of inpatient beds. The constant full census and projected growth of our BMT program required a permanent solution.

Purpose: The goal of this project was to determine if cyclophosphamide used for mobilization could safely be administered in the outpatient setting.

Interventions: A multidisciplinary team including home pharmacy, nursing staff, financial coordinators, CNS and physicians gathered to brainstorm ideas to address bed utilization.  Shifting cyclophosphamide mobilization to the outpatient setting appeared to be a viable solution.  The potential risks and benefits of this practice shift were explored.  Physician orders were modified and education was provided to the outpatient nurses.  A date for go live was set for a three month trial period.

 Evaluation:  The inpatient night shift nurse phoned patients on the evening of cyclophosphamide administration to assess symptoms and symptom management.  Patients completed a symptom experience survey at 24 and 48 hours post cyclophosphamide administration. 

Discussion: Cyclophosphamide for mobilization may be given safely as an outpatient.  To crucial goals of reducing costs and improving inpatient bed utilization were achieved.