The coronavirus disease 2019 (COVID‐19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 has challenged health systems to find innovative ways of delivering patient care while protecting staff from infection with the virus. As the COVID‐19 pandemic has continued to evolve establishing “hot spots” in various areas of the country, clinicians have learned more about caring for these patients. This has required the Department of Pharmacy at Thomas Jefferson University Hospital to constantly update the approach it has taken during this time, and the guidance which is provided for the pharmaceutical care of these patients. Because Philadelphia was in the initial stages of the pandemic within the United States, operations within the Department of Pharmacy at Thomas Jefferson University Hospital needed to be redesigned. This brief report provides an example of the swift changes that were made in the pharmacy practice model at a large academic medical center. Herein we describe the impact of the pandemic on the Department of Pharmacy at Thomas Jefferson University Hospital with a focus on clinical and operations aspects. The areas that will be highlighted in this report represent areas that required rapid and transformational change to the operations and/or clinical care in order to protect the health of pharmacists and allow them to continue to provide the necessary level of patient care.

IntroductionMethotrexate (MTX) a folate antagonist is often given in high doses (≥500 mg/m2) to treat a variety of disease processes. While inpatient administration has been the norm, outpatient administration, has been shown to be safe, effective, and patient centered. Here in we describe development of an outpatient HDMTX protocol and our initial experience.MethodsAll patients were to receive their first cycle of HDMTX in the hospital to ensure they tolerate it well and also to use this time to assist in training for home administration. The outpatient protocol involved continuous IV sodium bicarbonate, along with oral leucovorin and acetazolamide. Patients were required to visit the infusion center daily for labs and methotrexate levels. Clear criteria for admission were developed in the case of delayed clearance or methotrexate toxicity.ResultsTwo patients completed the safety run-in phase. Both patients tolerated treatment well. There were no associated toxicity. Methotrexate cleared within 3 days for all cycles. Both patients were able to follow the preadmission instructions for sodium bicarbonate and acetazolamide. The patients reported adequate teaching on the protocol and were able to maintain frequency of urine dipstick checks.ConclusionWe developed and implemented an outpatient protocol for high dose methotrexate. This study largely details the development of this protocol and its initial safety evaluation. More work needs to be done to assess its feasibility on a larger number of patients who receive more cycles in the outpatient setting.

e14012 Background: Improvement in supportive care medications, feasibility of outpatient management, and regulatory changes have led to a dramatic shift in the primary location of chemotherapy delivery from the inpatient setting to outpatient infusion centers. Over the last decade, centers in Europe and Canada have taken the next logical step – home based chemotherapy infusion. To our knowledge there is no systematic large scale initiative that has transitioned chemotherapy to the home in the United States. In order to implement a home based chemotherapy infusion program, we systematically scored anti-neoplastic agents for ease of administration. Methods: We reviewed all anti-neoplastic agents administered at our infusion center. Characteristics of each medication that could be a barrier to home infusion were identified. These included route and duration of administration, vesicant status, emetogenic potential, and duration of stability at room temperature. Scoring was determined by a multi-disciplinary team of pharmacists and oncologists (see Table). Higher scores indicated greater potential for home administration. Results: We reviewed 100 medications. The highest possible score was 8; the lowest possible score was -4. Agents ranged with scores from 8 (fulvestrant) to -1 (dactinomycin), with a median score of 4. The mode score was 3 (24 medications). The largest factor lowering the ease of administration score was stability at room temperature; score of -2 and -1 in 19 and 18 medications respectively. Conclusions: It is feasible to administer the majority of our chemotherapeutic agents in the home setting. The biggest barrier to administration at home is stability of medications at room temperature. This issue can be addressed by transporting and storing the medication in a refrigerated container. Expectedly, injectable drugs and medications with short infusion times that are stable at room temperature would be the easiest to administer in the home. Further analysis in ongoing to assess the financial feasibility and establishment of our home based program. [Table: see text]

260 Background: Patients with hematologic malignancies are often electively admitted for chemotherapy. Through an informal survey, patients expressed the desire to start chemotherapy within 4 hours of arriving to the hospital. Not only is this an important process to address to improve patient satisfaction but also to decrease hospital length of stay. As a result, we developed a quality improvement initiative to improve our median time to chemotherapy administration from 6 hours 41 minutes to a median of 3 hours over a 6 month period from 03/01/22 to 09/01/22. Methods: Baseline data was collected, from 9/1/2021 to 12/31/2021, on all Hematologic Malignancy patients’ electively admitted for chemotherapy at Thomas Jefferson University Hospital. Benchmarks in our steps to initiate chemotherapy include time from admission to placing initiate to treat order, time from initiate order to nurse releasing chemotherapy, time from nurse releasing to pharmacy review of chemotherapy order, and time from pharmacy review to administration of chemotherapy. Data was collected and analyzed. Potential interventions were discussed and prioritized. At the time of this abstract, 2 full PDSA cycles have been completed. Results: From 9/1/2021 to 12/31/2021, admissions for 40 patients with a diagnosis of a Hematologic Malignancy were evaluated. Median time from admission to administration of chemotherapy was 6 hours 41 minutes. The first intervention implemented on 03/01/22 involved a care team (i.e. chemotherapy pharmacists and nurse, bedside nurse) message via our electronic medical record communication system to notify them when the initiate to treat order was placed. PDSA 2 implemented on 05/04/22, involved releasing chemotherapy prior to confirmation of line placement. PDSA 3 is ongoing and focuses on pre-admission planning. See Table for detailed results of each PDSA. Conclusions: Increasing communication between key players in the chemotherapy process decreased time to chemotherapy administration by 2 hours. Feedback has been positive from all key players with no clear negative unintended consequences. Some of this improvement seen was due to an increased awareness of the provider to initiate treatment sooner. Ongoing interventions are currently underway with the hopes that these help achieve our goal of initiating chemotherapy in a median time of 3 hours.[Table: see text]