Chemotherapy infusion reaction training for medical oncology fellows: A checklist-based simulation exercise.

e17683 Background: The ability to recognize and treat a chemotherapy infusion reaction (IR) is essential for quality cancer care. Anaphylaxis is a severe allergic reaction that can lead to significant morbidity and even death. There is little data to guide how best to teach treatment of IR to medical oncology fellows (MOF). To improve our teaching of the subject, we conducted a PI project using simulation (SIM) and the use of checklists (CKL) to assess our MOF skills pertaining to IR. Methods: Program directors from 2 training sites in San Antonio, TX created a 10-minute SIM lab using a standardized patient and a standardized nurse during a chemotherapy IR. MOF from both institutions were asked to respond to a patient with severe hypersensitivity reaction (hypotensive) while receiving carboplatin for ovarian cancer. Half the MOF were given an IR checklist prior to their SIM encounter based upon NCCN guidelines. All encounters were videotaped and data recorded by 2 faculty. Results: 17 MOF (6 PGY-4s, 6 PGY-5s, and 5 PGY-6s) participated and had video reviewed. 8/17 were given CKL prior to their encounter. The mean time to stop the carboplatin infusion was 83 sec (±58) in the entire cohort. The mean time to stop the infusion in the CKL group was 53 sec (±53) vs. 110 sec (±51) in those without a CKL (p=0.04). The mean Infusion reaction checklist total score (9 items) was 5 (±1.7) in the checklist group compared to 4.8 (±1.2) in the group with no checklist. No fellows (0/17) performed all 9 CKL items. 63% of MOF checked vital signs (VS) up front in the CKL group compared to 67% without the CKL. 100% of fellows with a CKL gave H1 blockers versus 88% in group without CKL. 63% of fellows with CKL gave H2 blockers compared to 44% without. 100% of fellows (17/17) gave steroids. 50% of MOF with CKL gave EPI versus 22% without a CKL. Only 2/17 MOF (12%) verbalized the correct dose of EPI. Conclusions: CKL led to more immediate intervention and an increased use of H1 and H2 blockers. Our project suggests that we should focus our efforts on teaching MOF the importance of stopping the infusion immediately, monitoring of vital signs, and consideration of EPI for patients who have IR associated with hypotension.