Decreasing alteplase utilization in outpatient infusion: Enhancing safety and efficiency.

424 Background: Outpatient infusion nurses at The Valley Hospital often accesses patient central vascular access devices (CVADs) for the infusion of medications. When a CVAD does not have proper blood return, it is our practice to administer alteplase to restore patency. Alteplase use in the outpatient infusion area markedly increased in 2024 compared to previous years. Frequent alteplase use can lead to delays in treatment time, increased patient and caregiver dissatisfaction, and increased cost. The nursing staff and quality department came together to develop and implement interventions to decrease the use of alteplase and, in turn, improve the care of patients related to alteplase use. Methods: The first intervention focused on educating the nursing staff about the increased use of alteplase and its implications. Next, the electronic medication administration record was updated to include a hover feature over the alteplase administration charting section. This helped alert nursing staff that the patient had received previous alteplase doses at past visits and would then prompt an informed discussion between nurse and physician to further investigate the port’s functionality. Education updates and progress reports were delivered to the nursing staff, and their feedback was solicited in subsequent staff meetings. Results: The interventions were rolled out early in the fourth quarter of 2024. By the first quarter of 2025, there was a significant decrease in the use of alteplase in outpatient infusion. The average number of doses per thousand chemotherapy visits was 29.2 for the 3 rd and 4 th quarters of 2024. Our goal was to decrease this number by 50% by the first quarter of 2025. For the first quarter of 2025, the average number of alteplase doses per thousand chemo visits had decreased to 14.30. This was a decrease of 49% which exceeded our goal. Conclusions: Increased awareness of the nursing staff regarding the implications of repeated administration of alteplase use was integral in decreasing the frequency of its use. Education and improved documentation tools aided the infusion nurses’ ability to identify, track, and communicate about repeated alteplase administration with physicians and was effective in reducing alteplase use.