Code: D: MM Department Policy. Code: D: MM Entity: Fairview Pharmacy Services. Department: Fairview Home Infusion

Transcription

1 Department Policy Entity: Fairview Pharmacy Services Department: Fairview Home Infusion Manual: Policy and Procedure Manual Category: Home Infusion Subject: Administration of Medications - FHI Purpose: To provide guidelines for safe administration of medications in the home environment. Policy: I. FHI staff in collaboration determine the appropriate infusion control devices for patient care. II. Medications will be administered in the home setting using appropriate equipment and technology to ensure patient safety and to facilitate the achievement of desired outcomes. Procedure Related to Device Selection and Management I. The Fairview Home Infusion (FHI) Clinical Safety Committee will approve all infusion control devices used for patient care. II. III. FHI clinicians will evaluate and select the appropriate infusion control device for individual patients; options include manual, mechanical and electronic devices. The evaluation should include, but not be limited to: A. Patient age and medical condition(s) B. Prescribed therapy; mechanical or electronic devices should be considered for the following: 1. To provide more accurate infusion rate control than gravity or manual mode 2. To initiate and maintain very high or extremely low rates of flow 3. To administer potent drugs at specific and reliable infusion rates C. Patient ease of use IV. Electronic Pump Failure Management Page 1 of 12

2 A. If electronic pump fails, FHI will arrange for a pump to be delivered to the patient s home. B. If an equipment failure poses immediate danger to the patient, a second pump will be in the home to prevent an interruption in medication administration. 1.Patients receiving continuous inotropes will be sent a back-up pump. 2.Patients receiving other therapies (i.e. pain management, continuous TPN or chemotherapy), or patients living outside the metro area may fall into this category. The need for a back-up pump will be determined on a case by case basis. V. Upon initiation of a new therapy, or upon changing therapy, the device to be used will be documented in the medical record. VI. VII. Staff who select, use or teach patients about infusion devices are knowledgeable about the devices being used. Manufacturer s instructions are followed when using and teaching patients about equipment. Written instructions are provided to patients and caregivers. Medication Related Procedure: I. See Attachment I for preferred administration methods. See Attachment II for filtration summary. II. Medications are dispensed only after verifying the prescriber s order for the medication, the dose, type of access device, time and duration of administration. Any dose of a medication that falls outside the manufacturer s prescribing indication, literature citation, or standard of practice in the community will be verified with the prescriber for accuracy and supporting documentation that will substantiate the dose being prescribed. Prior to the dispensing of a medication, the appropriateness of therapy will be assessed. Refer to the following policies for more information: Establish new links A. Patient Care Orders B. Drugs Approved for Home Administration C. Assessment & Reassessment D. Medication Reconciliation Page 2 of 12

3 III. Prior to medication administration, the medication label will be verified by checking the patient s name, drug, dose, route, solution, time and duration of infusion, expiration date. Any questions regarding the accuracy of the information on the label will be resolved with the pharmacist prior to administration. IV. The Infusion pump program must be verified for accuracy prior to dispensing. No pump will be reprogrammed in Lock Level 0 by a patient or caregiver. (Lock Level 0 permits complete access to all programming and other operating features). A. All parenteral pumps will be programmed and reviewed by two (2) clinicians after the pump has been locked. Clinicians will verify the pump program using the pump programming verification record/ Prescription Form printed from CPR+. If a second clinician is not available, the same clinician must check the pump program twice, with at least five (5) minutes time elapsing between checks. B. Any pump program changes while a pump is in the home must be performed by a clinician in the home and verified by an office clinician via telephone. This must be documented in the medical record. C. If a clinician is not in the home, a newly programmed pump with pump programming verification record (if sent from FHI office) will be sent to the patient s home. D. Patient/ caregiver may titrate pain medication dose in Lock Level 1 (if order/program includes titration) over the telephone if previously instructed. Refer to Pain Management policy create new link V. Visually inspect all medications prior to use. Do NOT give medication that is cloudy or contains precipitates. All medication shall be used and discarded according to the directions on the medication label. VI. NOTE: Once opened, multi-dose vials of medication shall be dated, stored in the patient s refrigerator, and discarded if not used within 28 days. Observe instructions provided by the pharmacy for proper use, storage and handling of drug and solution containers. Administer medications at room temperature whenever possible Page 3 of 12

4 VII. VIII. Pediatric patients require special consideration. Refer to policy: Pediatric Home Infusion Therapy create new link Filters of appropriate size will be used as indicated by the patient s condition, prescriber order, pharmaceutical practice and/ or as recommended by the manufacturer. See Attachment II. Administration Related Procedure: I. CONNECTION, PRIMING, DISCONNECTION A. Select Necessary Equipment 1. Prescribed drug or solution 2. Intravenous administration set, if applicable (with appropriate sized filter, if indicated by drug therapy) 3. Alcohol swabs 4. PPE (personal protective equipment) 5. Prefilled normal saline syringe 6. Prefilled heparin syringe, if applicable 7. Infusion device, if applicable B. Administer Medication 1. Wash hands and don gloves. 2. Prepare administration supplies aseptically; prime tubing, spike fluid container, etc. as indicated by infusion method and by manufacturer directions. 3. Cleanse catheter end cap with alcohol swab for 15 seconds and allow to air dry completely prior to each access. 4. Flush catheter with normal saline to establish patency of the IV access device per protocol. See policy Access Device Management, General Policies for flushing guidelines. create new link 5. Cleanse catheter end cap. Aseptically attach administration set or syringe to access device. Regulate infusion or activate infusion device to deliver medication/solution. Never infuse more than one Page 4 of 12

5 medication or parenteral solution via the same administration set. 6. When infusion has completed, disconnect infusion device/tubing and discard expended supplies in appropriate receptacles. 7. Cleanse catheter end cap. Flush catheter with normal saline and/or heparin per policy. 8. Remove and dispose of glovesin appropriate receptacle and wash hands. II. ADMINISTRATION SETS A. Administration sets shall be changed utilizing aseptic technique immediately upon suspected contamination or when the integrity of the product has been compromised. B. Intermittent and Cyclic Therapy 1. Change administration sets with each dose for therapies provided on an intermittent basis (e.g., anti-infective therapy) unless otherwise ordered by the physician. 2. Change administration sets every 24 hours for cyclic TPN and IV hydration administration. C. Continuous Therapy Change administration sets at the following frequencies for therapies provided on a continuous basis, unless otherwise ordered by the physician: 1. Administration sets utilized for TPN and IV hydration change every 24 hours. 2. Administration sets for all other therapies (pain management, inotropes, anti-infective therapy) administered via an electronic infusion pump must be changed at least every 7 days. Refer to medication label for frequency of cassette/bag change; tubing must be changed at the same frequency. III. DOCUMENTATION A. Documentation of medication/solution administration shall include, but not be limited to: 1. Procedure performed Page 5 of 12

6 2. Venous access device 3. Medication/solution, dose, rate, date and time 4. Infusion device type 5. Site inspection 6. Patient tolerance/response 7. Vital signs as indicated 8. Follow-up plan External Ref: Joint Commission Applicable Standards Manufacturer s guidelines for equipment and supplies INS Policies and Procedures for Infusion Nursing; 4th Edition, 2011 Pediatric Dosage Handbook 16 th edition ( Taketomo) Extended Stability for Parenteral Drugs 4 th edition ( Bing) Trissel s accessed via the internet. Source: Clinical Managers, Quality Department Approved by: Director of Operations; Medical Director Date Effective: 01/01/1990 Date Revised: 02/14/1991, 03/14/1995, 02/10/1996, 02/29/1996, 04/30/1996, 03/19/1999, 1/1/2001, 10/04/2002, 4/04, 10/05, 10/06, 7/07, 02/2011, 7/2013, 4/2015 Date Reviewed: 7/2013, 4/ Page 6 of 12

7 (Attachment I) * Contact Material Supervisor or Pharmacy Manager before accepting DRUG IVP E E(+) MP G G(+) Pump ABATACEPT (Orencia) P N ACETADOTE (Acetylcysteine) P Y ACYCLOVIR P Y ALGALSIDASE (Elaprase) P N ALGLUCOSIDASE (Lumizyme) P N ALTEPLASE (line care treatment) N AMBISOME P N AMIKACIN P N AMPHOTERICIN (Ablecet) P N AMPHOTERICIN (Ambisone) P N AMPHOTERICIN (Fungizone) P N AMPICILLIN X P Y AMPICILLIN/SULBACTAM X P X Y ANTICOAGULANT CITRATE P N AZITHROMYCIN P Y AZTREONAM P Y BADD Solution P N CASPOFUNGIN (Cancidas) P X N CEFAZOLIN P X Y CEFEPIME P X Y CEFOTAXIME P X Y CEFOXITIN P Y CEFTAZIDIME P X X Y CEFTRIAXONE P X Y CEFUROXIME P Y CEREZYME (Imiglucerase) P N CHLORAMPHENICOL P N CHLORPROMAZINE P N CIMETIDINE P Y CIPROFLOXACIN P N CLINDAMYCIN P Y CYCLOPHOSPHAMIDE P Y Pump (+) Mix IVP Hep Comp Page 7 of 12

8 * Consult Pharmacy Buyer or Production Pharmacist to assure adequate supply is available DRUG IVP E E(+) MP G G(+) Pump CYCLOSPORIN A (Sandimmune) P N CYTOGAM (IVIG) P N D5/LACTATED RINGERS P N DACLIZUMAB (Zenepax) P N DAPTOMYCIN (Cubicin) P X Y DEFEROXAMINE P N DEXAMETHASONE P Y DIAZEPAM ( hospice only ) P N DIPHENHYDRAMINE P Y DOBUTAMINE P N DOLASETRON (Anzemet) P N DOPAMINE P Y DOXORUBICIN P Y ELAPRASE (See Algolsidase) P N DOXYCYCLINE X P N ERTAPENEM (Invanz) P X N FABRAZYME (Agalsidase Bda) P N FAMOTIDINE P Y FENTANYL IV, SQ, IT P Y FILGRASTIM (Neupogen) P N FLUCONAZOLE (Diflucan) P Y FLUOROURACIL P X Y FOSCARNET (Foscavir) P Y FOSPHENYTOIN (Cerebyx) P N FUROSEMIDE P Y GALSULFASE (Naglazyme) P N GAMMAGARD (IVIG) P Y GAMUNEX Liquid & SD (IVIG) P Y GANCICLOVIR (Cytovene) P X N GENTAMICIN P N GRANISETRON HCI (Kytril) P N HALOPERIDOL LACTATE P N HYDROMORPHONE IV,SQ P N Pump (+) Mix IVP Hep Comp Page 8 of 12

9 * Consult Pharmacy Buyer or Production Pharmacist to assure adequate supply is available DRUG IVP E E(+) MP G G(+) Pump IBANDRONATE (Boniva) P Y IDURSULFASE (Elaprase) P N IFEX/MESNA P Y IMIGLUCERASE (Cerezyme) P N IMIPENEM/CILASTATIN (Primaxin) X P N IMMUNE GLOBULIN 6% SEE IVIG P N INFLIXIMAB (Remicade) P N IRON SUCROSE- See venofer N IVIG - see brand N KETAMINE HCl P N KETOROLAC P N LACTATED RINGERS P X N LEVETIRACETAM (Keppra) P N LEVOFLOXACIN (Levaquin) P N LINEZOLID (Zyvox) P Y LORAZEPAM P Y LUMIZYME See Alglucosidase P N MAGNESIUM SULFATE P X Y MEROPENEM (Merrem) X X P Y MESNA P N METHYLPREDNISOLONE (Solu-Medrol) X P Y METOCLOPRAMIDE P Y METRONIDAZOLE 500mg P Y MICAFUNGIN P N MILRINONE (Primacor) P Y MORPHINE SQ IV P Y NAFCILLIN X P Y NAGLAZYME (Galsulfase) P N NATALIZUMAB (Tysarbi) X P N OCTAGAM (IVIG) P Y ONDANSETRON P X X Y Pump (+) Mix IVP Hep Comp Page 9 of 12

10 * Consult Pharmacy Buyer or Production Pharmacist to assure adequate supply is available DRUG IVP E E(+) MP G G(+) Pump OXACILLIN P Y PALONOSETRON (Aloxi) P N PANTOPRAZOLE (Protonix) P N PENICILLIN G K P Y PENICILLIN G Na P Y PHENOBARBITAL ( hospice only) P N PIPERACILLIN P Y PIPERACILLIN/TAZOBACTAM (Zosyn) P X Y PRIVIGEN (IVIG) P Y PROCHLORPERAZINE P Y PROMETHAZINE (only method) P N RANITIDINE P Y SMX/TMP(BACTRIM) P N TICARCILLIN/CLAVULANATE (Timentin) P X Y TIGECYCLINE P N TOBRAMYCIN P X Y TORSEMIDE P N VALPROATE (Depacon) P N VANCOMYCIN P X N VELAGLUCERASE ALFA (VPRIV) P N VENOFER ( iron sucose) P N VIVAGLOBIN (SQ+B) (SubQ) P N VORICONAZOLE (VFEND) P N Pump (+) Mix IVP Hep Comp Page 10 of 12

11 Key: IVP-Intravenous Push E-Elastomeric Ball E (+)- Elastomeric Ball plus patient adds drug MP-Minibag plus G-Gravity Bag G (+)- Gravity Bag plus patient adds drug Pump-Electronic Pump (+)- Patient adds to bag with pump Mix IVP-Patient reconstitutes/draws up P-Preferred X-Alternative method Heparin compatibility - reference is ESPD 4th ed 12/30/2010 ddd/kb (ATTACHMENT II) FILTRATION SUMMARY This is not an all-inclusive list. See manufacturer s recommendation for filters based on specific drug. Preparing medication from glass ampules X 5 micron filter needle 1.2 micron air eliminating filter 0.22 micron air eliminating filter Patients taught to reconstitute medications in the home for IV push administration X TPN (3 in 1, dextrose amino acids with lipids) X TPN (2 in 1, dextrose amino acids without lipids) * X Intraspinal infusions X Nafcillin via electronic infusion device X Chemotherapy via electronic infusion device X Gravity infusions via mini bag plus X Page 11 of 12

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