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

BACKGROUND: Despite treatment advancements, multiple myeloma remains incurable, with patients often experiencing relapsed or refractory multiple myeloma. Developments in bispecific antibody (BsAb) therapies have shown promising efficacy in managing this disease. BsAbs present challenges around treatment-related toxicities and resource utilization, particularly during inpatient monitoring. OBJECTIVES: This quality improvement project aimed to evaluate a nurse-developed guideline for BsAb step-up dosing in an outpatient setting. METHODS: This project used a framework that 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: The guideline supported safe BsAb step-up dosing in an ambulatory setting, with timely toxicity detection and effective remote symptom assessment through telephone follow-up. Nursing engagement increased via structured training and workflow integration, demonstrating that BsAb therapies can be safely managed in this setting.