Large number of IV Chemo treatments

mappers · Sep 6, 2012

Where I live, most chemo is given in an outpatient setting. All of the outpatient settings around here are affiliated with a hospital and most are on the same campus, but are not part of the hospital. My place is across the street and we do not have any of the hospital services for the patients (housekeeping dietary, etc.) There is an outpatient chemo area in the hospital, but it has about 10 chairs and is really more for overflow and blood transfusions. We have 14 chairs and 11 beds and do about 40 chemo tx a day. We also infuse IV Iron, ABX, fluids, drugs like Zometa and Reclast, K+ and Mag, etc. No blood though, the blood bank is at the hospital.

notthesun · Sep 6, 2012

Thanks for the response, I really appreciate it! You said that outpatient settings are affiliated with a hospital but they do not have any of the hospital services...Do the outpatient clinics have autonomy in how they regulate their facility (with regards to following USP 797, hospital regulation, etc) and in which type of safety products they use when preparing/administering IV chemotherapy treatments (such as use of biological safety cabinet, closed-system transfer device, etc)? Or does the hospital decide on everything and the outpatient clinics follow suit?

I have been trying to figure out how hospitals, IV clinics, doctor's offices, and home infusions centers differ in the level of safety precautions they are taking when handling antineoplastic drugs. Are they all following USP 797 and are they following recommendations from NIOSH and using a closed-system transfer devices (such as PhaSeal) when mixing/administering IV chemo treatments?

mappers · Sep 9, 2012

I can only tell you about our practice, so here it goes. We were an individual private practice up until about 2 1/2 years ago when we were purchased by the hospital chain across the street. I've been with them two years. From what I understand, before the hospital bought us, we had pharmacy techs who mixed chemo and we did have a hood. The clinic did not really fall under any regulatory agencies - no Joint Commission, nothing. After the hospital purchased us, we now are classified as an outpatient arm of the hospital and follow all the same regulations they do. We now have a pharmacist at our site, we have three hoods (two chemo, one non-chemo). About 2 months ago we started using a closed transfer system on the IV bags. We've had a total pharmacy remodel and now fall under the USP 797 codes, etc.

Our pharmacist has taken the lead on all this in cooperation with the hospital pharmacy director. We are still completely self sufficient. We have our main guy and a part-time person. There have been one or two pharmacists from the hospital who have trained at our place to fill in, but we've only needed them once or twice and that was in the late afternoon when most chemo mixing is finished. I think pharmacists from the hospital would be overwhelmed by the volume of chemo mixed at our place daily, compared to what the hospital does.

As far as supplies, the hospital tries to have us use the same vendors that they use for cost purposes. I think we do on a lot of things, but some things they've tried to get us to change we've put our foot down. They tried to make us switch angiocaths recently, but we won. They made us go to a safety huber needle (the ones we used before didn't have safeties on them, but for patients going home with their needles in, they laid very flat on their chests and were more comfortable.) They did let us trial several types and pick the ones we preferred instead of automatically using what the hospital uses.

Our practice has been around a long time and our nurses (the ones who have been with the practice for a long time) probably know more about chemo and cancer than most of the hospital staff. We are lucky in that they respect our opinions most of the time.

Does this answer your questions?

KelRN215, BSN, RN · Sep 18, 2012

It depends on the cancer. Some protocols involve getting admitted for every cycle and others involve almost NO inpatient treatment. I do pediatric home care now and have a large oncology population on my service. Kids with ALL are only inpatient for chemo during induction and consolidation. The majority of their treatment is completed on an outpatient basis... and, in fact, a large portion of it is done at home. I also have several kids with neuroblastoma... they receive all of their chemo inpatient as their protocol involves 24 hr infusions, lots of pre and post-hydration and usually 1-2 autologous stem cell transplants. When I worked inpatient, I did neuro-onc and that, too, varied by the specific tumor. Low grade tumors are treated exclusively on an outpatient basis. The more high-grade tumors that have nastier protocols involved being admitted for 24 hr infusions of doxorubicin or daily etoposide/cytoxan. I would say that, overall, more chemotherapy is given outpatient than inpatient. But, yes, there still ARE hospitals that do a lot of chemo on a daily basis.