PHAST AND FURIOUS: UTILIZING POINT OF CARE TESTING IN THE MANAGEMENT OF METHOTREXATE CLEARANCE

• Published in: Oncology nursing forum Vol. 51; no. 2; p. 43B
• Main Authors: Parra, Jessica, Wolfe, Jennifer, Bhardwaj, Aarti
• Format: Journal Article
• Language: English
• Published: Pittsburgh Oncology Nursing Society 01-03-2024
• Subjects: Chemotherapy; Electronic health records; Nurses; Nursing care; Oncology; Patient satisfaction; Point of care testing; Toxicity; Urine
• ISSN: 0190-535X; 1538-0688

High dose methotrexate (HDMTX) is a chemotherapy that can cause significant toxicity, including acute kidney injury (AKI), by crystallizing in the renal tubules and delaying drug clearance. AKI can lead to increased morbidity, delays in treatment, and decreased renal function. Monitoring methotrexate (MTX) clearance is key to the prevention of AKI. Urine testing is used to ascertain pH levels to determine if sodium bicarbonate (NaHCO3) is needed to alkalinize the urine because methotrexate and its metabolites are more soluble at higher pH levels. Increased turnaround times (TAT) for urine samples sent to the lab caused delays in NaHCO3 adjustments, increasing MTX clearance times and lengths of stay. The purpose of this project was to improve adherence to the HDMTX clearance protocol by expediting urine pH results through on-unit point of care testing (POCT). A multidisciplinary taskforce, consisting of nurses, APPs, physicians, POCT staff, and Epic support collaborated to implement urine pH POCT on three oncology units at a large academic teaching hospital in New York City. Three Siemens Clinitek urine analyzers were purchased and data jacks were installed on each unit, allowing data collected by the analyzers to be transmitted to patients' electronic health records (EHR). The nursing quality team partnered with ordering providers and Epic support to create a new order specific to the point of care test. One hundred thirty-one nurses completed competency training on how to operate the analyzers. This project went live in August 2023, and our quality team will be collecting data on the time between urine pH results and NaHCO3 administration. Decreased TATs allow nurses to administer NaHCO3 in a timelier manner, which results in better management of MTX levels and toxicity. These improvements contribute to shorter lengths of stay and increase patient satisfaction. On-unit testing of urine pH eliminates the need for samples to be sent to the main lab, where TATs could be over an hour. POCT grants real-time results, allowing nurses to administer NaHCO3 more expeditiously, increasing adherence to the HDMTX clearance protocol and decreasing the potential for AKI. Decreasing the risk of AKI improves patient outcomes, satisfaction, and leads to decreased lengths of stay. Receiving continuous feedback from frontline nurses and tracking time from test result to NaHCO3 administration are keys to measuring the success of this project.