Outpatients Receiving Infusions or Apheresis on Inpatient Units

Transcription

1 Outpatients Receiving Infusions or Apheresis on Inpatient Units Purpose: To provide information on the process for scheduling outpatients to receive infusions or apheresis on inpatient units on weekends or major holidays. Background Information The Journey Clinic is not open on weekends or major holidays (New Year s Day, Memorial Day, July 4, Labor Day, Thanksgiving Day, and Christmas). Outpatients who need an infusion or apheresis on a weekend day or major holiday need to go to an inpatient unit for this care. These patients are NOT referred to as Admissions or Observation Patients, but as Outpatients who are receiving infusions in an inpatient setting. This is important for billing purposes. The goal is for all patients to receive infusion services Monday through Friday in the Journey Clinic. Weekend infusions are only intended for those patients who have a medical necessity for a weekend infusion despite having received full infusion services during the previous week. The weekend option is not intended to be an option of convenience for families whose schedules make it difficult to come to clinic during the week. Please call Journey Clinic manager anytime with questions: o Phone: o Pager: Procedure Identification of Patients Requiring Infusion or Apheresis 1. The Journey Clinic nurse manager will survey Journey Clinic BMT and Heme/Onc providers, clinic pharmacist, and clinic charge nurse on Thursday afternoons about outpatients who will need weekend/holiday infusions. This team will stay in telephone contact with each other on Fridays in case there are patients to add to this list. 2. Other services should call the Journey Clinic manager ( ) to discuss the needs of their patients. Patient Placement 1. All BMT patients needing infusion or apheresis (collections) services will be placed on Unit Non-BMT patients will require a determination from the ordering provider about whether the patient has an infection. If there is NO known infection, the patient will be placed on Unit 4 if there is bed space. If there is a known infection, the patient will be placed on Unit 5 or 6.

2 Communication Between Inpatient and Outpatient Staff 1. As soon as it is identified that an outpatient from any pediatric service will need an infusion or apheresis on a weekend or major holiday, clinic staff (nurses, providers, manager, or solid organ transplant coordinator) must call the Unit 4 charge nurse (Ascom * Dial from outside line or *14410 from internal phone line). This allows for the planning of weekend/holiday staffing on the inpatient unit(s). 2. The person responsible for completion of the scheduled admit form and communication is: a. An outpatient staff member (nurse manager, provider, or clinic nurse). This should be negotiated clearly by the team. b. For solid organ transplant (SOT) patients, the nurse and/or CMA coordinator for that service is responsible. 3. The person identified in #2 will: a. Confirm with the apheresis administrator ( ) what time the patient will begin apheresis, if applicable. b. Complete a Scheduled Admit Form (Control + Click on link, or go to Fairview Intranet>Business Services>Access Services>UMMC, Fairview Patient Placement>Scheduled Admit Form) OR call Patient Placement (ph: ) and inform them which unit the patient should go to. i. Enter free text on the form that the patient will remain an outpatient, and NOT be considered an admission nor an observation patient. ii. Request an interpreter if needed. c. Call the inpatient charge nurse (Unit 4 charge nurse Ascom: *14410, Unit 5 charge nurse Ascom: *14340) to hand off the important clinical details so that weekend inpatient charge nurse and staff are prepared. i. For SOT patients, include information about which SOT/nephrology attending physician is on call on that day. d. For SOT patients who have received apheresis in the Journey Clinic during the preceding week, call t he Journey Clinic Infusion nurses ( ) and clinic manager ( ) to notify them that patient placement has been arranged. e. For SOT patients, contact the SOT attending physician to: i. Inform him/her of the planned apheresis on the inpatient unit, and ii. Ask him/her to place orders (signed and held) at least one day prior to the apheresis (per Orders section below). Orders should include medications and diet orders. Apheresis orders are handled by the apheresis team. 4. Patient Placement will confirm the infusion patient(s) with the inpatient unit charge nurse during bed meeting the evening before the patient is to arrive. Communication with the Family 1. The person/team responsible for communication with the family is: a. Journey Clinic staff (non SOT patients)

3 b. SOT care coordinator (SOT patients). If the patient is seen in the Journey Clinic during the week, please ask the clinic nurses to inform the family of when/where to arrive on the weekend or holiday. 2. Time of arrival a. Patients requiring infusions should arrive at Admissions at 10:00am on the day of the infusion. This mid-morning arrival time accomplishes two goals: i. Some morning inpatient discharges can occur before the infusion patient arrives, and ii. The infusion can be completed primarily within one nursing shift, for staffing purposes. b. Patients requiring apheresis: time of arrival at Admissions will coordinate with the time that the apheresis team provides its service. Orders 1. Orders will be entered by the attending physician, fellow, or advanced practice practitioner (APP). Exception: apheresis orders are managed by the apheresis team. 2. Orders must be entered the day before the weekend/holiday infusion so that the inpatient pharmacy so that the inpatient nurse can immediately release the medication orders as soon as the patient arrives. This expedites the preparation by pharmacy of the infusion. 3. Blood product orders must be entered within a blood product order set. Order sets should also be used for other orders whenever possible. 4. Orders should include medication and diet orders. 5. All orders need to be associated with the correct diagnosis. For example, BMT is not a specific enough diagnosis to support an infusion of cidofovir. 6. Orders should be signed and held pending the arrival of the patient. 7. When the patient arrives on the unit, the nurse will: a. Release the orders, and b. Call the pharmacy to notify them that he/she has just released a medication for a weekend infusion patient. This should shorten the time required for pharmacy to prepare and deliver the medication. Patients Receiving Blood Transfusions On Friday (or the business day prior to the holiday), the Journey Clinic Infusion RN staff will: 1. Verify that there is a signed and current Consent for Blood Transfusion in Epic in the Media tab. a. Click on the description header within the Media tab in Epic. Consent for blood transfusion will be in the alphabetic list. b. The outpatient consent is valid for one year and covers a weekend/holiday transfusion. 2. Verify that there is a current Type and Screen (T&S) and that it will cover the weekend/holiday. If the T&S is not current: a. Request that the provider enter an order for it, and b. Make arrangements for the patient to come in for blood to be drawn.

4 3. Contact the Blood Bank to prepare the blood for the next day. 4. If there is anything complicated/time-consuming about the blood preparation (e.g., the patient has antibodies), alert the inpatient charge nurse. When the Patient Arrives on the Inpatient Unit 1. Review the diet order and follow the process for obtaining a meal tray for the patient. (See page at end of this document.) Nursing Documentation on Inpatient Unit 1. Document a basic head-to-toe assessment on the Peds PCS (Patient Care Summary). 2. Document status of central line or peripheral IV on the IV Assess flowsheet. 3. Record Start Time and Stop Time for all medications on the Medication Administration Record (MAR). This is done by clicking in the cell where the infusion is listed and choosing the correct option from the drop-down menu. 4. In a nursing note, describe succinctly the important details of the infusion encounter. For example: John came to Unit 4 today to receive Leukocyte-reduced packed red blood cells irradiated - 2 UNITS for a Hgb of 7.6 today. Patient denies any fevers and/or signs of infection. CVC intact/patent. Premedication of Acetaminophen and Benadryl given prior to the start of the infusion. Transfusion completed without complication. Vital signs remained stable throughout. CVC hep-locked without difficulty. CVC Dressing and caps changed while on Unit 4. Patient seen by Sarah Preusser, PA and left in stable condition at approximately Physician/APP Role on Inpatient Unit The provider should review the patient s history in Epic, speak with the referring physician about any clinical questions, and document a note in Epic regarding the infusion or apheresis and any unexpected event that occurs. Communication with Journey Clinic If something occurs with a patient during the infusion or apheresis (e.g., transfusion reaction) that will affect the Journey Clinic on the next clinic day, the inpatient charge nurse can leave a message on the Journey Clinic phone line ( ) that will be retrieved on Monday morning (or the next clinic day following a holiday). [ Source: Beth Andrews Ann Hagerman Reviewed by: Outpatient Infusion on Inpatient Unit Workgroup Date effective: 11/13 Date reviewed/revised: 12/13

5 Food Menu: Outpatients receiving Infusions/Apheresis on Inpatient Setting Instructions: 1. View the patient s active diet orders entered by provider 2. Print this page and have patient/family member circle from the food items available 3. RN or NST calls to place the order 4. The food tray is delivered to the front desk (not patient s room) and thus the responsibility of unit staff to deliver to patient Breakfast Options (7am to 11am): Please circle 1 entrée and 2 sides Pancakes with syrup French toast with syrup Scrambled eggs Hashbrowns Bacon Sausage Vegetarian sausage Blueberry muffin Bagel with cream cheese Lunch Options (after 11am): Please circle 1 entrée, 2 sides, and 1 dessert Chicken strips with BBQ sauce Cottage cheese Hamburger or cheeseburger with ketchup and mustard Yogurt: select strawberry, raspberry or peach Grilled cheese sandwich Garden salad: select either ranch or Macaroni and cheese french dressing Peanut butter and jelly sandwich: select white bread or wheat bread Vegetable: select corn, carrots, or green beans Penne pasta: select meat sauce or Potato chips marinara sauce Mashed potatoes with gravy Fruit: select orange, apple, banana, or red grapes Cookie: select chocolate chip, sugar, or oatmeal raisin Brownie

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