1. Evaluation of Rasburicase Administration at University of Iowa Hospitals and Clinics
Katie Gaspar, Ahmed Abdeldagir, Christine Behrendt, Michael Boller, Alec Gates
Background
Inappropriate prescribing is an issue often found in healthcare that leads to increased costs and unfavorable patient outcomes.
Tumor lysis syndrome (TLS) is an oncologic emergency resulting in high uric acid level which can lead to acute kidney injury. Risk associated with high uric acid can be mitigated with IV fluids, to decrease concentrations, and allopurinol, to prevent further formation. Rasburicase is a recombinant form of uricase and is used to break down uric acid in TLS.
Results
Discussion
Diverse set of reasons for inappropriate rasburicase administration, with no concomitant allopurinol administration as the most common factor
Overall uric acid lowering is observed in patients after rasburicase administration
Inappropriate ordering leads to high amount of unnecessary costs
Total of 84 rasburicase administrations across 62 adult patients
9 patients with consecutive doses
5 patients with non-consecutive doses
63% of administrations appropriate
58% met initial criteria
3 cases withheld fluids in heart failure
1 case withheld allopurinol due to allergy
Conclusions
Majority of rasburicase use at UIHC is appropriate and effective but there is still significant room for improvement
Improvement in appropriate ordering could provide significant cost-savings
Objectives
Determine appropriateness of rasburicase use at University of Iowa Hospitals and Clinics (UIHC) in order to:
Improve patient outcomes
Provide cost savings
Assumes patients receiving rasburicase inappropriately would not have received the drug at all, or would have received an appropriate dose
Cost analysis based on wholesale price of $993 for 1.5 mg rasburicase vial
Future Directions
Practice guidelines for the appropriate use of rasburicase in TLS at UIHC in order to:
reduce medication errors
achieve better patient outcomes
improve cost savings
Methods
Retrospective chart review of all UIHC adult oncology patients that received rasburicase in 2017.
Criteria for appropriate administration:
Uric acid > 8 mg/dL
Concomitant allopurinol
Concomitant fluids
Flat dose of 3 mg or 6 mg administered
Minimum of 24 hours between doses
Examined parameters relevant for rasburicase use including:
Rasburicase dose
Pre- and post-dose uric acid level
Monitoring times of uric acid levels
Concomitant ordering of allopurinol and fluids
References
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