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Objectives: This evaluation assessed the compliance to Ascension Health’s new guideline for prescribing rasburicase and the appropriateness of a single dose.
Study Design: The study was a retrospective chart review.
Methods: Electronic health records were examined to identify all patients between June 2014 and May 2015 who received at least one dose of rasburicase during their admission. Based on institutional guidelines, rasburicase should be prescribed only by a hematology/oncology clinician for a patient with current hyperuricemia (uric acid > 8 mg/dL) or who is classified as a high risk patient at a dose of 0.2 mg/kg with a maximum dose of 6 mg. Charts were reviewed to determine indication for usage, administered dose, and the area of practice of the prescribing clinician. Data collected included the uric acid level, weight based dose, the number of doses administered, and rational for any repeat doses. Descriptive statistics were used to assess compliance.
Results: A total of 41 adult and 10 pediatric patients received rasburicase. Overall, there was a compliance rate to the guidelines of 85.4% in the adult and 40% in the pediatric populations. In adults, 100% of patients met the prescriber restrictions while 85.4% of patients met the patient criteria for receiving a dose of rasburicase. In pediatrics, 40% of patients met the prescriber restrictions while 100% of patients met the patient criteria.
Conclusions: Guidelines were generally utilized by providers for adult patients. Less compliance was seen in pediatrics, with renal and cardiac patients making up a large percentage of rasburicase doses. Further review of rasburicase literature in pediatrics is warranted to determine expansion of guidelines.