Pneumocystis jirovecii is an organism that can cause life-threatening pneumonia (pneumocystis jirovecii pneumonia; PJP). The fungus can take advantage of a suppressed immune system, so patients with multiple myeloma (MM) who are on immunosuppressive therapy are at an increased risk for contracting the disease.
One way to predict whether a patient needs prophylaxis for PJP is to look at their CD4 T cell count. A decreased CD4, attributable to immunosuppression, can increase the risk of PJP. However, constantly monitoring CD4 in each patient can be costly.
“The cost of a CD4 lab at Huntsman exceeds $1500—regardless of insurance provider,” Carrie Bellerive, BSN, RN, BMTCN, Huntsman Cancer Institute, Utah, reported in a talk at the International Myeloma Society’s 6th Annual Nursing Symposium.
To address the cost, she and other nurses at Huntsman developed and implemented an algorithm to determine the patients most likely to contract PJP.
“We determined that if a patient is on prophylaxis, we discontinue monitoring the CD4 until the patient meets criteria for resumption per the algorithm,” she explained.
An article published in Oncology Nursing News outlines the prophylactic algorithm, which involves treatment with trimethoprim-sulfamethoxazole and other agents on a case-by-case basis.
Bellerive believes all institutions treating these patients should develop a shared best practice for monitoring CD4.
To view Huntsman’s algorithm, click here.
Nurse-developed algorithm helps identify pneumocystis pneumonia risk