Dear OncoLink "Ask The Experts,"
Our institution recently began using continuous infusion 5-FU via pump for outpatients. Can you please tell us how your protocol works for these pumps?
Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:
When our patients use these pumps, they are controlled (that includes all programming, refilling, battery changes, and alarm fixes) by the home infusion team. If a patient is admitted to the inpatient units, the inpatient pharmacy makes a replacement drug (if the doctors want to keep the infusion going), and we change the infusion over from the outpatient pump to an in-house pump. If the patient is discharged, home infusion sends someone by to restart the infusion.
At home, patients are given a 24-hour on-call home infusion nurse whom they should contact if they hear the infusion alarm or have any other issue during the night. They are told to NOT try to fix things themselves, but just call.
As for home infusion, the protocol for filling the order is as follows:
When the order for 5-FU is entered by the pharmacist, he/she also enters orders for how the pump is to be programmed (reservoir volume and continuous rate). The order is then double checked by another pharmacist to make sure that the drug and pump orders were entered correctly. Once the drug is prepared, the pump is programmed by one of the clinicians here according to the orders on the label.
The pump is then double checked by another clinician (nurse or pharmacist). It is then taken to the patient, connected, and started by the home infusion nurses.
As a side note, each and every clinician involved in home infusion, including pharmacists and field nurses, undergo a pump competency review annually.