ChrisF

Thanks everyone for your replies and input. We are currently using the Alaris pumps. Our rationale has also been to prevent inadvertant fluid overload in the younger population. The only problem we really have with our pumps is the discrepancy from the number of mls in the IV bags and number of mls the pump is reading/dispensing. This has caused 24 hour bags of chemo to run over 25 - 26 hours.

Can I please find out how many of you are still using buretrols on your pediatric population? Is there a cut-off age where you stop using them? If you don't use them, when did you stop? We are looking at this issue now as it relates to our pediatric patients and our pediatric oncology patients. Thanks in advance for everyone's input.

I am hoping that the oncology community can help me. I am in need of information regarding the turn around times for receiving chemotherapy. I am interested in the amount of time it takes pharmacy to deliver the medication from the time it is faxed to them. Can my fellow oncology nurses please share this information with me? We are having issues with excessive times to receive the chemo from pharmacy and this is with both outpatient chemo and inpatient chemo. We are trying to streamline the process so we can receive our medication safely but in a timely manner. Can you please include the size of the facility you work at? I want to make sure I am comparing facilities fairly. If you have a great system for requesting your medications, can you please share? Chris

At the hospital I work, they have started to do adult chemo. The Pedi Onc dept has been in place for over 17 years but the adult dept was shifted to another hospital about 12 years ago. Now with two docs admitting adults, they are asking the peds nurses to go over and give the chemo. The hospital told us "chemo is chemo". The staff of the pedi onc dept is very divided over this. While some of the drugs are the same, they are used in a different manner for cancers we have very little education on. What is the feeling of others on this? We just are not that comfortable doing the adults. Are we just fearing the unknown or are we right to feel the way we do? We just don't know. They are trying to train staff on the adult floor to take over but it is a very slow proccess and will take time. We have actually moved one patient to the peds floor as the patient needed a cont. 24 hour drip for 7 days and there weren't any qualified nurses on the adult floor to handle it. This created an issue as staff is used to doing mouth care, prophylatic abx for pcp, eye drops etc and and physician refused to do these. We are just looking for ideas of what other facilities do. Does anyone do both peds and adults? Chris

I think people are confusing the term "certification" with "provider" and "local inhouse certification". You can become certified through ONS or APHON. These are national tests that give a national certification. The requirements to take the test vary but usually at least 1000 hours of practice giving chemotherapy and supportive care. More information on the tests can be obtained from the ONS or APHON websites.

We have a physician that gives into our parents and direct admits patients to our inpatient unit. While we understand the ER is not fun for anyone, it is the feeling of the staff that a febrile patient is safer if they are admitted through the ER. We have had patients direct admitted with sepsis which can then becomes a life threatening situation. My question is...how does everyone else handle this type of situation? Our standard of care is to give the first antibiotic within one hour of arrival. Pharmacy is not allowing us to over-ride Fortaz in our Omni-cell on the floor. They state the reason that the ER can over-ride it is because a physician is present. So we are now faced with some very sick children that cannot get their first dose of antibiotic for approximately 3 hours. Are we being unrealistic in wanting availability of medication or admissions through the ER? Is there anything we can say or show to the pharmacy director to plead our case? Chris

We are currently undergoing an update of competencies and practices. Would love to see yours. Chris

No BMT...basic peds hem/onc with some clean med surg overflow. We have Hepa filters in all patient rooms but that is it. Chris

Fairly new to this site but thought I would ask a few questions and learn from others. I have recently been placed in a position of writing or re-writing policy and procedures for my unit. Even though I have 17 years here doing pediatric oncolgy, I feel that we have fallen into the "this is the way we have always done it" mindset. Would others be willing to share advice on how there units are managed? We are a designated 17 bed hem/onc unit. Staffing ratio varies. We are looking at our safety issues as related to chemo order processing, administration, disposal, etc. We also have issues with child life. They would like the playroom to be open to all....patients and visitors. There is a concern over infection control as we allow our neutropenic patients to be out of their rooms if they have not had a fever in 24 hours. I am sure I will have other questions as I get further into this new job...but thanks in advance for all suggestions and help Chris