Evaluating a Nurse Guideline for Bispecific Antibody Safe Step-Up Dosing in an Ambulatory Setting: A Continuous Quality Improvement Approach

Background Multiple myeloma (MM), a hematologic malignancy characterized by the uncontrolled proliferation of plasma cells, leads to complications such as anemia, bone lesions, and renal impairment. Despite treatment advancements, the disease remains incurable, with patients often experiencing relapse or refractory disease. Recent developments in bispecific antibodies have shown promising efficacy in managing relapsed/refractory MM, improving response rates and progression-free survival. However, these therapies present challenges related to treatment-related toxicities and resource utilization, particularly during inpatient monitoring. Objectives This quality improvement project (QI) aimed to evaluate a nurse-developed guideline that transitioned bispecific antibody step-up dosing to an outpatient setting. Methods Utilizing the Institute for Healthcare Improvement (IHI) Continuous Quality Improvement (CQI) framework, the project involved systematic training and data collection to assess the effectiveness of the guideline in detecting toxicities, monitoring patient outcomes, and integrating telephone follow-up into nursing workflows. Findings This QI project demonstrated the successful development and implementation of a nurse-led guideline for the safe outpatient administration of bispecific antibody step-up dosing in patients with relapsed or refractory multiple myeloma (MM). The model demonstrated feasibility, safety, and strong nursing engagement through structured education, workflow integration, and iterative refinement, ultimately enhancing patient experience and resource utilization.