Outpatient infusion center standards/protocols and equipment

  1. So I work as a float in an outpatient setting and have been asked to train at a small infusion clinic that is next to/part of our internal med/specialty offices. The center is open 3 days a week and staffed by one nurse, who has started to train me. There is a doctor a couple rooms over who is available if needed. We are connected to the hospital but not officially part of it (i heard from our manager we are supposed to call 911 vs the emergency code if we have a code situation).

    Infusions are biologics for autoimmune d/os --rheum and crohn's.

    So the nurse sees up to 6-7 pts at a time for infusions, although I wouldn't feel comfortable seeing that many. She does remicaide and rituxan along w other drugs. IV equipment is not needless, which I have never seen. Pumps are very old (>10 yrs would be my guess- I have been a nurse 10 yrs and I have never seen pumps like this). All BPs/P done by hand. All meds are mixed by us. Flushes have to be drawn up. Only remicaide and rituxan go on pumps; rest are 30m-1hr infusions where cc/min is calculated using gtts/min. Lines aren't flushed before they are used.

    I spent a day in the hospital's outpt infusion center and the nurses there were surprised that our equipment is not needleless and said it might even be a safety/jacho type violation. THey have regular pumps, easier to use iv catheters, and 3 nurses + secretary for almost the same # of pts (although they are open longer and 5+ days a week). THey have all meds delivered from pharmacy and were surprised that we did rituxan infusions ( she said they don't do them bc they don't have some sort of chemo training).. THey use auto BP machine which seems much more efficient.

    I also found out that they take VS more frequently during infusions than in our clinic, and titrate remicaide differently (as in, more slowly)..

    I am getting nervous as I am wondering if we are following the standard of care.

    Does anybody have any info on this? I also don't think there are any sort of standard protocols on what to do if XYZ happens in the clinic.
    With our switch to a different computer system, there were a lot of issues and there are often infusion orders which are wrong doses that she recognizes that I am worried I wouldn't. Also the correct premeds aren't put in for pts and there are no standing orders for emergencies.

    I'll stop now..
    Last edit by ivyleaf on Jun 19, '17
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    About ivyleaf, ASN, RN

    Joined: May '09; Posts: 294; Likes: 113


  3. by   dream'n
    Nope, nope, nope. I would not work in such an outdated infusion area, that's ridiculous! Rituxan is a serious drug, that can have serious adverse reactions. I only gave it when I became chemo/biotherapy certified.
  4. by   IVRUS
    I don't have the correct number of fingers to count that many violations!!! Exit stage left... I too would not subject my license for this "infusion clinic".
  5. by   llerkl
    I wasn't aware until recently, that "private" smaller free standing infusion areas are held to different standards than larger, hospital affiliated centers. Not exactly sure what the standards are. I know the nursing staff must be trained in compounding, to be able to mix the medications. I would also think chemo therapy certification of SOME type would be necessary if administering Rituxan.
    Sounds scary though, compared to the infusion area I work at!!