Procrit Orders

[mappers]

Does anyone work in an environment where you frequently give Procrit? I'm in an outpatient chemo/Dr.s office. We never actually have the orders in the computer for this. Usually in the dictation it will say, Procrit weekly or something. We have to make a judgement, based on Hgb, last week's hgb, and dx on how much to give, whether to hold it, etc. Several of us feel that this is outside our scope of practice and have said things to the manager about it.

I did a search on our BON's website and don't see anything either.

Just wondering how other places do it.

[blondy2061h, MSN, RN]

The only times I've given Procrit is with JW patients who refuse blood transfusions. I'm not sure about the outpatient world, but we very rarely give it inpatient anymore as studies have shown it's associated with increased mortality from tumor growth. When we do give it, we have specific orders. Usually they'll just write the order x1, then order it again when they want it again. It sounds like what you're doing is outside an RNs scope of practice, unless you have specific protocols, like "Give Procrit q1wk as needed to keep hgb >10." That's how our transfusion orders are (though obviously not once weekly ).

[mappers]

We have a matrix that we use. If the DX is MDS or Renal, then we try to keep Hgb around 12. If it is due to chemo, then it's 11. This has to do with what medicare will cover. If hgb drops by a gram, then we increase by 25%; if it increases by a gram (but is still lower than the above numbers) we decrease by 25%. What kills me is it says as HGB "approaches" 12, you may decrease dose by 25%. What the heck does that mean??? Or you'll find in the dication that they want to keep HGB around 11.5....that doesn't fit the matrix either.

I really hope our new nurse manager gets this changed.

[Reno1978, BSN, RN]

The procrit orders need clearly defined guidelines for dosage adjustments and reasons for it to be withheld. A "judgement call" by the RN could be defined as "practicing medicine" if he/she is choosing medication dosages without consulting a clearly defined policy, in my opinion.

If you were to ask 5 nurses who work where you work what to do with X patient with Y lab results and there isn't consistency with the answers, a change is needed.