Rapid Hydration - Improving Patient Safety & Satisfaction

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Children receiving nephrotoxic and bladder toxic chemotherapy must undergo intravenous hydration prior to medication administration to protect the urinary system from its negative effects. Adequate hydration can be a rate limiting step, resulting in late evening start times of chemotherapy, extended inpatient stays, and consequently, patient and family dissatisfaction. Later start times lead to safety concerns. These include multiple handoffs between caregivers, limited availability of chemotherapy certified pharmacists, decreased experience of overnight nursing staff, and resident learners triaging bedside nurse concerns as the physician who wrote chemotherapy is no longer present on site at the time of medication initiation.

Key stakeholders, including oncologists, nursing staff, and pharmacists, assembled to identify barriers to earlier chemotherapy start times and find solutions to shorten this delay. The goal of this quality improvement pilot was to initiate chemotherapy prior to shift change, with the global aim of improving patient safety and satisfaction. Baseline data of chemotherapy start times was obtained from retrospective chart review of the electronic medical record. A multidisciplinary team collaborated to identify key drivers of efficient timing of chemotherapy. Upon review of the published literature, implementation of a rapid hydration protocol appeared to be safe and effective in shortening the time for patients to meet urine parameters for chemotherapy. After discussion with attending physicians and education of nursing staff, a rapid hydration protocol was initiated for children receiving Cisplatin, Cyclophosphamide, Ifosfamide, and Methotrexate.

Preliminary data revealed that the average time from completion of pharmacy preparation to nursing administration of chemotherapy was over 6 hours. This was secondary to not yet meeting parameters to initiate chemotherapy due to inadequate hydration, inpatient bed availability, nursing shift change, and competing nursing priorities with other medications. Upon implementation of rapid hydration, the average time from chemotherapy availability to administration shortened significantly to an average of 2 hours, 32 minutes.

Implementation of rapid hydration led to earlier chemotherapy start times and decreased inpatient length of stay. Overall, this initial PDSA cycle allowed for a consistent ability to safely initiate chemotherapy prior to shift change when more team resources are available, with the additional benefit of improved patient and family satisfaction.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1869

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