IPOP Induction for Patients With AML

The importance of inpatient/outpatient (IPOP) unit induction and its role in the treatment of acute myeloid leukemia.

Katie Culos, PharmD, BCOP: Can you describe the structure of the IPOP [inpatient/outpatient]? How many beds are in there? What’s the most common reason for admitting into the inpatient unit?

Yehuda Deutsch, MD: We have about 16 beds and chairs. The rooms have regular hospital beds, and sometimes they also have the type of chairs you would have in an infusion-chemotherapy suite. The nurses are typically outpatient nurses, but most of them have had a lot of experience in inpatient care. They treat both. We have a dedicated nurse practitioner who sees all these patients and nurses on a daily basis, as well as the physician who’s on the inpatient service. Many patients will have fevers. Some of them will have to get admitted into the hospital. But they’re basically already in the hospital, and they can be directly admitted. We can have hospitalists come and see them, sometimes other specialists. Any scans or tests that need to be done can be done immediately. Also, laboratory tests can all be done inpatient. There’s no need to send a laboratory test to other commercial labs. We receive results immediately.

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: From a pharmacy standpoint, since the unit is physically located on the inpatient side, the inpatient pharmacy will compound any medications that are needed, and we have a dedicated IPOP pharmacist who works Monday to Friday.

Katie Culos, PharmD, BCOP: I would assume that your IPOP is also open on the weekends.

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: It is open on weekends, but we consolidate it then, and the inpatient pharmacy team takes care of the IPOP patients.

Yehuda Deutsch, MD: Being open on the weekends is critical. Just because it’s a weekend doesn’t mean that patients aren’t going to need transfusions, antibiotics, and other care.

Katie Culos, PharmD, BCOP: You will have your patients go there instead of going to an emergency department or somewhere else, correct?

Yehuda Deutsch, MD: Yes. We will triage patients there. If the patients aren’t feeling well, we can have them come in, especially on the weekends, and try to take care of them and avoid the emergency department.

Katie Culos, PharmD, BCOP: Thanks to both of you for this.

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: Thank you for having us. This is a very exciting time to be taking care of AML [acute myeloid leukemia] patients. We’ve seen an explosion over the last 2 years in the number of drugs we’re able to use, and now we also have a lot of questions regarding sequencing. But overall, it’s an exciting time as we’re seeing the paradigm shifting to the outpatient setting. There are more opportunities for pharmacists to be involved.

Katie Culos, PharmD, BCOP: Thank you for a rich and informative discussion. Before we conclude, I’d like to get any final thoughts.

Yehuda Deutsch, MD: Thank you for allowing me to be a part of this. It’s great to be here and to talk about something that I’m most passionate about, which is treating patients with AML. It is such an exciting time to be doing this. As Amanda said, we have so many new medications to treat these patients, and patients are doing so much better—less toxicity, more remissions, more cures, more survival. It’s really amazing. Many of these treatments don’t necessarily have to be given in the hospital, which also improves patients’ quality of life, and these are things that can really be done anywhere in the world and don’t necessarily have to be treated at an academic university. It can be treated in the community as well. We just need to educate people about the different treatments and potential toxicities and monitoring.

Katie Culos, PharmD, BCOP: Thank you again. To our viewing audience, we hope you found this Pharmacy Times® Practice Pearls® discussion to be useful and informative.