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CAR-T cell Education For ICU and BMT Nurses

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Background: 

Chimeric Antigen Receptor T-cell  (CAR T-Cell) therapy is rapidly developing for the treatment of lymphoma and other cancers.  This therapy is evolving quickly from bench to bedside, but there is limited oncology and intensive care nursing published literature.  Patients can become critically ill very quickly and just-in-time education is not an ideal method for this new therapy.

A four-hour class was created to provide information for the bone marrow transplant (BMT) and intensive care unit (ICU) nurses.  Content included a review of the immune system, assessment, CAR T-Cell complications including cytokine release syndrome and neurotoxicities, appropriate medications, and other available immunotherapies. The last topic presented was the nature and purpose of Phase 1 and Phase 2 clinical trials. 

Purpose: 

A four-hour immunotherapy class was created for BMT and ICU nurses with the following objectives:

-Increase knowledge of the immune system and how CAR T-cell therapy works to enhance the patient’s own immune system
-Improve outcomes of patients experiencing adverse reactions of cytokine release syndrome (CRS) and neurotoxicities by helping nurses to recognize symptoms
-Explain appropriate interventions and the purpose for medications used for patients experiencing adverse reaction
Methods:
-Consulted published articles about clinical CAR T-cell therapy
-Reviewed YouTube videos from physicians who had treated patients with CAR T-Cell therapy
-Interviewed institutions that had experience treating patients with CAR T-cell therapy for input on necessary education
-Engaged 4 BMT nurses working toward BMTCN certification: Met and explained new therapy, Divided into 4 topics presented by BMT nurses (immune system, immunotherapy, CRS, CAR T-Cell development)
-Educational session was repeated 3 times with 82 nurses attending from both the ICU and BMT units
-Pre-test given before information presented
-Identical post-test repeated at the end of each session
Discussion:
Education for this new therapy has been effective for care of this patient population. Post-test scores improved for 78% of the nurses who attended the education and completed both the pre- and post-test evaluations.

The nurses have cared for 13 patients receiving this therapy. In the 9 patients who experienced CRS and neurological adverse reactions, they received appropriate interventions. All of the patients have been discharged to home.

Conclusion : 

Understanding and treating toxicities caused by the Immunotherapy CAR T-cell infusions are new to nursing and the medical staff.  Just in time education for the management of this complex patient population is not ideal.   Providing the bone marrow transplant and intensive care unit nurses with 4-hour education classes provided key information on this new biologic therapy. Because nurses attended these educational sessions they are able to recognize toxicities and anticipate required interventions which has optimized care for these patients.

 

 

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