ANAHEIM, CA — Use of hypersensitivity toolboxes containing the necessary medications and appropriate administration supplies enables quick nurse response to anticancer therapy-induced hypersensitivity, results of a study presented at the Oncology Nursing Society (ONS) 44th Annual Congress have shown.

Accrediting agencies recommend that institutions develop a standard of practice (SOP) for treating anticancer therapy-induced hypersensitivity reactions. At West Penn Hospital in Pittsburgh, Pennsylvania, Lisa Ciafre, RN, MSN, of the Allegheny Health Network Cancer Institute, and colleagues identified an opportunity to improve the time it takes to initiate treatment of hypersensitivity reactions, with the goal of improving patient outcomes.

For this study, the investigators analyzed internal hypersensitivity data from 2017, then developed a multidisciplinary subgroup within the Anticancer Therapy Council to improve response practices. The subgroup identified variations in hypersensitivity response processes across their network and conducted time trials to identify a best practice for obtaining necessary medications and administration supplies. The time-trial study compared the following processes:

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No toolbox Necessary drugs are obtained individually from an automated dispensing cabinet (ADC) and the necessary supplies for administration are obtained from a supply room or work station on wheels (WOW).

ADC hypersensitivity drug trigger Selecting hypersensitivity in the ADC automatically opens hypersensitivity protocol-specific medication drawers and appropriate administration supplies are obtained from the supply room or WOW.

ADC hypersensitivity toolbox Selecting hypersensitivity in the ADC provides a nurse with a toolbox containing all hypersensitivity medications, needed supplies, and a treatment algorithm as a reference.

Emergency medication toolbox A tackle box containing medications and supplies needed to respond to emergency situations in a clinical setting, including hypersensitivity-designated medications and supplies, is obtained from a locked room or cabinet. The emergency medication toolbox is not kept in the ADC.

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The time trials involved 3 different nurses completing each process and the researchers calculated an average of the time each practice took to complete. Each time trial started 30 feet from the ADC or toolbox storage location; the nurse had to obtain all medications and appropriate administration supplies per the Hypersensitivity Protocol SOP. The time trial started when the nurse left the start position to obtain the medication and supplies, and stopped when the nurse returned to the start position. No nurse coaching was permitted.

The average times for each method were reported as 3.15 minutes for no toolbox, 2.03 minutes for ADC hypersensitivity drug trigger, and 1.04 minutes for both the ADC hypersensitivity toolbox and the emergency medication tool box.

Each toolbox contains the following medications: epinephrine 1 mg vial or epi pen, albuterol neb solution 2.5 mg/3 mL, diphenhydramine 50 mg vial, ranitidine 50 mg vial or famotidine 20 mg, and hydrocortisone 100 mg vial. Supplies included: 3 ml safety syringe with intramuscular needle, two 3 mL luer lok syringe, 2 blunt fill 18 gauge needles, and continu-flo solution set (for famotidine) or 1 blunt fill 18 gauge needle and 1 luer lok syringe. Plus, each toolbox includes a copy of the hypersensitivity algorithm and protocol.

Study limitations or extraneous variables included the need for respiratory therapy to administer the nebulizer in inpatient settings, varying ADCs across settings, and the variance of medication and supply storage between settings. The results of this study demonstrate a need for hypersensitivity toolboxes, concluded Ms Ciafre.


  1. Ciafre L, Reiser P. Improving the response time in the treatment of anticancer therapy induced hypersensitivity reactions. Oral presentation at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA.

This article originally appeared on Oncology Nurse Advisor