Patient with zofran pump and no orders

[BSNbeauty]

There are 2 patients on our floor that was admitted with zofran pumps. There were no orders in place neither is their a policy on how to maintain the pumps. Both patients came to the hospital with these pumps and the docs just wrote orders to maintain the pump without any dosage, directions or anything. The nurses were basically told not to touch them. Thankfully, pharmacy brought this to our NM attention and demanded that the pumps be discontinued so that the hospital would not be held liable if anything went wrong.

My question is: How does your facility handle patients that come in zofran pumps that was not placed by the facility?

[KelRN215, BSN, RN]

Agree with using the insulin pump policy as a guideline.

It upsets me that pharmacy was "demanding" that the pumps be discontinued, but it's also not surprising. Pharms are not bedside and not patient advocates. In this case, the pharm, nurse and doctor should work together to do what's best for the patient, not just the hospital re:liability.

ETA: The pump would be better than ATC IVP to maintain a constant level of antiemetic, even while hospitalized. The risk of electrolyte loss, dehydration, and lower level of pt comfort, I believe, would override any fear of liability and, for the sake of the patient, should make pharm and the MD think twice about discontinuing it.

When I worked in the hospital, the pharmacy once told me that a patient could not have her anti-retrovirals because A) the pharmacy didn't carry them and B) the patient's mother brought them in the pill box that she uses at home and not the original pharmacy container. The hospital did not carry the specific drug that it was and the pharmacist felt it was completely reasonable to just say "well, the child can't have her drugs while she's in house." Right, abruptly discontinuing ARVs for a patient with HIV is a good idea. Needless to say we gave them anyway.

I have never heard of a zofran pump, even as a home health nurse who works primarily with oncology patients. Most of my patients' parents would not be able to manage this, though, which is probably why.

When we had patients on insulin pumps in house, we managed them the same way other posters have said. The patients (or, well, in our case the parents since I'm talking about pediatrics) were expected to manage them and they had to show us the settings and every time it changed, we had to check it with 2 nurses.

[wooh, BSN, RN]

Just because the alternative zofran IV around the clock is available, doesn't mean it's better for the patient. Would pharmacy demand a baclofen pump be discontinued as well?

[T-Bird78]

When I worked in the hospital, the pharmacy once told me that a patient could not have her anti-retrovirals because A) the pharmacy didn't carry them and B) the patient's mother brought them in the pill box that she uses at home and not the original pharmacy container. The hospital did not carry the specific drug that it was and the pharmacist felt it was completely reasonable to just say "well, the child can't have her drugs while she's in house." Right, abruptly discontinuing ARVs for a patient with HIV is a good idea. Needless to say we gave them anyway.

I have never heard of a zofran pump, even as a home health nurse who works primarily with oncology patients. Most of my patients' parents would not be able to manage this, though, which is probably why.

When we had patients on insulin pumps in house, we managed them the same way other posters have said. The patients (or, well, in our case the parents since I'm talking about pediatrics) were expected to manage them and they had to show us the settings and every time it changed, we had to check it with 2 nurses.

Zofran pumps are typically for pregnant women suffering with hyperemesis gravidarum. It's issued by home health and managed by the pt via daily phone calls with the home health nurse. The rate is adjusted by the pt. I was on one for a month. No fun.

[T-Bird78]

Agree with using the insulin pump policy as a guideline.

It upsets me that pharmacy was "demanding" that the pumps be discontinued, but it's also not surprising. Pharms are not bedside and not patient advocates. In this case, the pharm, nurse and doctor should work together to do what's best for the patient, not just the hospital re:liability.

ETA: The pump would be better than ATC IVP to maintain a constant level of antiemetic, even while hospitalized. The risk of electrolyte loss, dehydration, and lower level of pt comfort, I believe, would override any fear of liability and, for the sake of the patient, should make pharm and the MD think twice about discontinuing it.

Exactly. The IV zofran and pushes don't stay in the system near as long. I was on the zofran pump for a month because oral and even IV zofran (along with oral reglam and phenergan) weren't working; I needed the more continuous, round-the-clock dose.

[blondy2061h, MSN, RN]

Now I'm wondering why we don't use zofran drips with our oncology population with intractable nausea.