Effect of Prophylactic Extended-Infusion Carboplatin on Incidence of Hypersensitivity Reactions in Patients with Ovarian, Fallopian Tube, or Peritoneal Carcinomas.

STUDY OBJECTIVE: To determine whether extended-infusion carboplatin, initiated at approximately the eighth cumulative carboplatin cycle and prior to development of carboplatin hypersensitivity, reduces the incidence of carboplatin hypersensitivity reactions in patients with ovarian, fallopian tube, or peritoneal cancer. DESIGN: Retrospective chart review. SETTING: Large integrated health system. PATIENTS: A total of 326 patients with ovarian, fallopian tube, or primary peritoneal cancer who received at least eight cumulative cycles of carboplatin between January 2007 and September 2014 were included. Of these, 161 patients received all doses of carboplatin infused over 30 or 60 minutes (standard-infusion group [total of 1317 carboplatin cycles]), and 165 patients received the 3-hour extended infusion of carboplatin administered at approximately the eighth cumulative cycle and prior to development of a hypersensitivity reaction (extended-infusion group [total of 1527 carboplatin cycles]). MEASUREMENTS AND MAIN RESULTS: Baseline characteristics were similar between the groups, except significantly more patients in the extended-infusion group received triple premedication therapy prior to infusion (p<0.001). Hypersensitivity reactions occurred in 64 patients (40%) who received standard-infusion carboplatin and 40 patients (24.2%) who received extended-infusion carboplatin (p=0.0027). The median cycle of hypersensitivity reaction development did not differ significantly between the groups: 9 cycles in patients who received standard-infusion versus 11 cycles in patients who received extended-infusion carboplatin (p=0.06). Through regression analysis, the premedication regimen received prior to carboplatin infusion was the only variable significantly associated with hypersensitivity reactions (odds ratio 0.59, 95% confidence interval 0.36-0.97, p=0.038). CONCLUSION: Patients who received extended-infusion carboplatin experienced a lower incidence of hypersensitivity reactions than patients who received standard-infusion carboplatin, which may be attributed to the triple premedication regimen received more frequently in patients in the extended-infusion group.

Implementation of a training program to improve pharmacy services for high-risk neonatal and maternal populations.

PURPOSE: A training program aimed at increasing pharmacists' role in the care of high-risk maternal, neonatal, and pediatric patients is described. SUMMARY: In preparation for the planned expansion of a large Ohio hospital's maternal and neonatal critical care services, the pharmacy department developed a training program to increase the knowledge and skill sets of staff pharmacists, especially those who lacked residency training. The program also supported the department's transition to an integrated patient-centered pharmacy practice model. Clinical practice guidelines, policy statements, and other sources were used to develop a series of 57 one-hour lectures on a wide range of topics in maternal-neonatal critical care. The lectures were delivered one morning each week, every other week, over 30 months, with additional case-based homework assigned; a passing score (80%) on all module examinations and homework assignments was required for continued course participation. Trainees who completed the voluntary program earned a certificate from the department head and continuing-education credit from the Ohio State Board of Pharmacy, and they were eligible to engage in expanded rounding and patient counseling activities. The program appeared to have a positive impact on patient satisfaction and efforts to reduce medication misadventures in the neonatal intensive care unit. CONCLUSION: The implementation of a training program to educate non-residency-trained pharmacists in selected areas of maternal, neonatal, and pediatric health care helped enable the expansion of pharmacy services to include admission, daily, and discharge counseling.