As far as patients receiving an infusion in a hospital-based outpatient infusion clinic, is there a standard or specific requirements for the basic patient assessment? What do you do as part of your daily assessment? Do you get vital signs, breath sounds, heart, etc? We are trying to determine the standard for the assessment because our current assessment seems to be overkill. Currently we do a full head to toe assessment monthly on each patient as well as a daily mini assessment when the come in for their infusion. We spend an abundance of time gathering data that is not pertinent or necessary in regards to the infusion. Of course, we want to make sure we have the data we need, but how necessary is it to know their shoe size?
Also, does anyone have a list of outpatient criteria for patients coming to IV therapy? Such as : is the patient stable? Ambulatory? Continent/incontinent? on feedings, etc? We often find ourselves receiving patients who are unstable that should not have been sent to an outpatient IV therapy clinic. Any help or examples or help would be greatly appreciated.
Thanks,
Kimberly Wischmeier BSN, VA-BC
Our outpatient infusion clinics are different. Out outpatient chemo infusion suite has a recurring appointment under a set account number. There is an "Admission" assessment for the cancer center, then a per-visit assessment, which does include a head-to-toe assessment along with standard pain/IV etc assessments which are congruent with our inpatient side. It does not have the blood bank in the same building, so transfusions are sent to our other area:
The non-hem/onc infusions are administered in our day surgery. There, the patient has an "Admission" assessement which is the same as the pre-admission history for a surgical patient, which is associated with that specific account number. This account is only valid for 1 month, and then must have new consents/etc, new account number. This is then re-entered each month. The infusion flowsheet reviews the the history and gives a head-to-toe assessment. If we can't get charity infusions for a patient, and have to have them come in daily for short term therapy, it is just the flowsheet. The Med Rec is reviewed with the patient at each new account number and the patient is asked daily if there are any changes to their medications.
I could see that the shoe size may become relevant if it changes suddenly, maybe with severe edema or a new foot wound :) The pre-infusion assessment should consist of all elements that are pertinent to that infusion. vital signs tend to be important to establish the baseline, breath sounds - I always auscultate for crackles & it is just habit to move on to heart sounds. If a patient cannot tell me if they have skin breakdown it is my duty to look. I think of the global assessment of the RN as opposed to the targeted assessment of the LVN (at least in my state) and what my duty to the patient is; it may be overkill, but it is my job to do certain things. If a patient cannot reposition themselves, I must do so (q2h if laying, q1h if sitting), pressure ulcers occur even in an outpatient setting. Also does depend on the infusate - remicade vs. transfusion vs. hydration - what are the pertinent assessments for each? It just depends.
Criteria for outpatient infusion is just that - does the prescribed therapy require an inpatient setting with 24 hour nursing monitoring? What is the post-infusion monitoring required? Does it require an acute inpatient facility, LTAC, skilled nursing? Should it be a home therapy? Our heme/onc clinic is considered a doctors office and is not covered by our code team or RRT, where the day surgery has a crash cart and is covered by our teams. What emergency resources do you have available, what is your protocol for transfer to an ED or EMS?
Kathleen Crowe BSN CRNI VA-BC