Protocols for Subcutaneous Transitions

EP: 1.The Shifting to Subcutaneous Oncology: Recent FDA Approvals

EP: 2.Subcutaneous Value: Efficiency and Access

EP: 3.Workflow Wins: Scheduling and Pharmacy Impact

EP: 4.IV vs Subcutaneous: Clinical Considerations

EP: 5.Reimbursement Realities: Billing for Subcutaneous

EP: 6.Implementing Subcutaneous Without Disruption

EP: 7.Operational Shifts: IV to Subcutaneous

EP: 8.Staffing and Scheduling for Subcutaneous

EP: 9.Patient Selection and Counseling

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EP: 10.Protocols for Subcutaneous Transitions

Successfully transitioning patients from IV to SubQ therapy requires a coordinated, multidisciplinary effort. While clinical appropriateness and patient preference are central to the decision, implementation hinges on system-wide readiness. Operational leaders must involve pharmacy, nursing, information technology, and administrative teams to assess the impact on workflows, resource allocation, and patient experience. For example, pharmacy workflows must adapt to different preparation and handling requirements, and nursing teams may need training on new injection techniques and managing patient expectations for SubQ therapy, which can feel more personal and time-sensitive.

EMRs also play a pivotal role in this transition. Systems need to be updated to ensure that SubQ formulations are easily selectable and correctly ordered, minimizing the risk of unintended administration errors. Protocols should support clear documentation of dosing, administration site, and adverse effects, especially when the same medication is available in both IV and SubQ formats. Furthermore, scheduling systems must account for shorter chair times and different staffing needs, especially in infusion centers that operate with lean resources. These technological upgrades are essential to avoid gaps in continuity and to support future automation or reflex pathways.

While the concept of automatic or reflexive switching from IV to SubQ formulations may seem efficient, it currently requires careful oversight and clinician-patient dialogue. Patients may have specific logistical, emotional, or medical considerations that make one route more appropriate than the other. Moreover, treatment intent and reimbursement constraints vary by formulation and indication, adding layers of complexity. Until systems and teams mature in SubQ use and supporting technology catches up, these switches should be deliberate, guided by shared decision-making and informed by robust protocols. Long-term, as SubQ therapies become more common, systems may evolve to support more automated approaches with appropriate guardrails.