Reducing harm from paclitaxel infusion using titration rate: A quality improvement project

The number of paclitaxel infusion reactions was observed as the highest among all Cancer Medication Infusion Reactions (CMIR) in the Cancer Care and Hematology Clinic at Scarborough Health Network (SHN) despite the use of pre-medication. This quality improvement project was aimed at reducing the number of paclitaxel reactions and reducing extended chair time due to infusion reactions.

Our quality improvement strategy focused on monitoring paclitaxel reaction rates while using a standardized titration rate strategy for patients receiving the first three lifetime cycles of paclitaxel infusion for solid tumours or hematologic malignancies. The titration rate was calculated with a variety of drug volumes that are used within the Scarborough Health Network. Findings from the 4 months of piloting the titration rate strategy were compared to the previous 4 months when titration rates were not used.

Four months after introducing the new strategy, there were 35.71% paclitaxel reactions when a titration rate was used as compared to 51.35% reactions when a titration rate was not used. Patients who received paclitaxel infusion using titration rates increased the scheduled chair time to 30 minutes to allow for slower infusion rates, while patients with hypersensitivity reactions (HSRs) required an extra 3 hours of chair time that was not pre-planned.

There were fewer HSRs after the launch of the titration rate strategy in patients receiving paclitaxel for the first three lifetime cycles. This strategy also reduced overall chair time at the clinic.