Rituxan and staffing guidelines

Published

Just wondering if there are any guidelines out there regarding appropriate staffing and medications specifically Rituxan. Last night we had a patient recieving Rituxan, it was started at 4PM and was to run over 12 hours. The patient had had a previous reaction to Rituxan, so the gtt was slowed down for this infusion. On nights, we had 32 patients on the floor and 5 nurses plus one aide. We also are a telemetry on unit and had 15 people on tele. Since we have no monitor techs, the charge nurse is responsible for watching the monitors and as a result does not take a pt assignment. The nurse with the Rituxan had a patient assignment of 5, the other 3 had 9 patients including another patient recieving a 24hr infusion of 5fu. In addition, we had a pt with a heart rate in the 30's with 3-4 second pauses. The supervisor couldn't understand why we wouldn't take any more admissions. She felt the aide could do 15 minute vs on the rituxan patient and that would free the nurse up take a larger assignment. Of course we explained that the nurse needed to do the vitals herself because the patient needs to be assessed q15minutes. My question is, is there guidelines out there for how many patients one nurse can have while running Rituxan? How about Natrecor? I've had 10 patients, 2 on natrecor and one getting blood. We do have staffing guidelines but it's done by the numbers, not the acuity. Just like to know what the recommended guidelines are. And yes, the Rituxan should never have been started late in the afternoon to begin with.

Thanx

Sailingshoes

93 Posts

You're correct that the Rituxan didn't need to be started at 4p. It could have waited until the next day without changing results. Reaction to Rituxan can be fatal as you may already know. I work in an outpatient oncology center and would definitely have that pt within our view during infusion. ONS may have guidelines regarding nursing ratio in the hospital setting - check ons.org At our facility we don't have more than 5:1 When we give Rituxan the first time the pharmacist mixes the dose in 2 separate bags so that if there is a reaction with the first bag, the pt can come back the next day for the second (assuming the reaction is not severe) and of course both doses are titrated but not over 12 hrs since we are a day facility. Sounds to me like it was handled poorly and you have justified reason for concern.

Dolce, RN

861 Posts

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

Eeek! There are just so many things scary about this situation I don't know what to say. I don't have any guidelines to point you to, but anytime a tele nurse has 9 or 10 patients something is just bound to go wrong.

My advice? Quit your job and find one with reasonable staffing ratios.

esrun00

110 Posts

Specializes in cardiac, oncology. Has 22 years experience.

Are the nurses on your floor chemo certified? In both the hospitals I have worked at they required that prior to being able to give chemo. I can't imagine hanging chemo without knowing what could happen and how to handle it. And to have to monitor cardiac patients as well, IMO a lawsuit waiting to happen.

blondy2061h, MSN, RN

1 Article; 4,094 Posts

Specializes in Oncology. Has 15 years experience.
Are the nurses on your floor chemo certified? In both the hospitals I have worked at they required that prior to being able to give chemo. I can't imagine hanging chemo without knowing what could happen and how to handle it. And to have to monitor cardiac patients as well, IMO a lawsuit waiting to happen.

I agree.

Specializes in ED. Has 20 years experience.

Yes, we are all chemo certified on my floor. Only chemo nurses can hang or monitor chemo. We are also basic coronary certified and there are many of us that are also ACLS. I have been on this floor for the past 10 years and when I first started, we were telemetry only. It was just a couple of years ago that some brilliant manager type thought to move the oncology to our unit so they could expand the ortho unit (the big money maker in our hospital). No one was happy with the move and we all thought having those two specialities were not a good mix. I personally don't care for the oncology aspect, I'm a cardiac nurse at heart (no pun intended). Now we the new mix, we really have to adjust our numbers but we keep getting the brush off from the higher ups. We have a new NM and she is also unhappy with the staffing numbers and is looking for some solid guidelines to improve them. I've stayed for so long because I work with some of the smartest, most dedicated nurses I've ever seen. We work as a team and no matter how awful the night is we keep things bearable.

nursesher

1 Post

I am interested in staffing ratios for the 1rst dose of Rituxan. Our chemo committee is looking at whether to return to our original policy that the 1rst dose was 1:1, or at least 2:1 with a pt in the same room. I am amazed at the staffing levels in these notes! On the oncology/medical floor I work on evening shift, we have 4-5:1 ratio with a NAC for 17-24 pts, max 2 NAC's for the 34 pt floor. The telemetry unit has 3:1 ratio, rarely 4:1 with no NAC's, also a charge and crisis RN. Even then, it is usually very fast paced. Do you have any extra help? Are the Rituxan pts visible from the front desk?

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