INFLECTRA Infliximab Infusion 1,2 & 3

Transcription

1 DEPARTMENT OF RHEUMATOLOGY DAY CASE ADMISSION RECORD PATIENT DAY CASE BOOKING REQUEST To be completed by Consultant, Registrar requesting day case Admission Hospital No. Surname Forename Address INFLECTRA Infliximab Infusion 1,2 & 3 Post Code Telephone Number SPECIAL INSTRUCTION FROM CONSULTANT/ REGISTRAR of Birth Reason for Day Case INFLECTRA- Infliximab- INFUSION Diagnosis Current Medication Medication Dose Medication Dose Known Allergies Please record any known allergies- if know to have allergies- Patient to wear RED Name Band 1 P a g e

2 Blood Tests- results HB WBC Platelets Neutrophils ESR Urea Sodium Potassium Creatinine Albumin Alk phosphatase Total Protein Bilirubin AST CRP s-blood Results s-blood Results s-blood Results 2 P a g e

3 Urine Tests- results Nitrate Protein Leukocyte Blood s-urine Results If >+ Protein, blood, nitrite or patient symptomatic of UTI, please send MSU Discuss with Doctor s-urine Results If >+ Protein, blood, nitrite or patient symptomatic of UTI, please send MSU Discuss with Doctor s-urine Results If >+ Protein, blood, nitrite or patient symptomatic of UTI, please send MSU Discuss with Doctor IMPORTANT CONTACT NUMBERS Rheumatology Nurses Bleep 1780 Rheumatology SHO Day Case Coordinator Ext 6176 Rheumatology SpR Bleep 1351 RGH/RS Bleep 1068 SAY/FCM/ANC Bleep 1354 EW/JML bleep P a g e

4 Patient information check list- to be completed by nursing staff Infusion 1 Infusion 2 Infusion 3 :- Has the patient previously had a Inflectra- Yes/No Infliximab Infusion Yes/No If yes, did the patient experience any side Yes/No Yes/No Yes/No effects during or immediately after or following discharge Yes/No if yes please document in Nursing Notes and discus with Doctor. Identification Band applied RED ID Band if known to have allergies Patient provided with AR UK Leaflet Infliximab Version Patient Observations Records on Vital Pac Patient Weight Recorded Has the patient any signs or symptoms of infection? Chest Infections- Yes/ No if current symptom send Sputum Specimen Skin/Wound infections- Yes/ No if current send wound /skin swab Has the patient any wounds, ulcers or skin breaks Yes/No Digestive Tract- Yes/No abdominal pain, change in bowel habit Other Type Has the patient been investigated for gastric ulcers etc:- Yes/No Has the patient received any form of Vaccination in day leading up to Inflectra- Infliximab Infusion Is the patient a Diabetic Yes/No If yes please check blood sugar prior to Blood Sugar Blood Sugar Blood Sugar Inflectra- Infliximab infusion If Blood Sugar result> 7 Female Patients- Is the patient currently pregnant Yes/No Male Patients- has the patient recently fathered a child with partner Yes/No If the patient has felt sleepy or dizzy during previous infusions, advise that they do not drive or work machinery Has the patient commenced any new medication since last appointment with Rheumatology Department Yes/No 4 P a g e

5 :- Patient Orientated to Day Case Suite Toilet/ Refreshments/ Magazines et Is the patient about to have or had recently any surgical procedures Yes/No Has the patients general state of health changed since appointment with Rheumatology Department Yes/No Has the patient recently been investigated for a cancer Has the patient had any recent cardiac events, uncontrolled hypertension or angina Has the patient any ankle oedema or breathlessness Yes/No Does the patient experience significant Fatigue Offer "Tired of Being Tired Programme information Does the patient have an "Informal Carer" Friend/Relative/ Neighbour-offer Carers Information Other issues discussed during the day case admission related to Inflectra- Infliximab Infusion Yes/No If yes please document in Nursing Notes DAS29- Rheumatoid Arthritis Patients- only Infusion Pump Number Inflectra- Infliximab Batch Number Infusion 1 Infusion 2 Infusion 3 Tender Swollen VAS CRP Tender Swollen VAS CRP Tender Swollen VAS CRP DAS28 DAS28 DAS28 Infusion Rate- please record infusion rate 5 P a g e

6 Care pathways All clinical staff involved with Infusions should be familiar with how to use an integrated care pathway If you are recording an event, which is predicted by the ICP, then you just sign against that predicted intervention in the column provided. If your intervention is not in line with the pathway, you must record this as a variance in the nursing documentation with the action you will take to try to bring the patient back onto the pathway. Care given by health care assistants and student nurses must be countersigned by a registered nurse. There are many NOTES pages for you to write free text about the care given to the patient by you. These notes should always be dated and timed. All ICP s are chronological so you should be able track the care given very easily DOSE- Adults ADULT DOSE for RHEUMATOID ARTHRITIS - ALWAYS CHECK DRUG CHART ADULT DOSE for Ankylosing Spondylitis and Psoriatic Arthritis- 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter; treatment with 10 mg/kg IV may be considered for patients who respond and then lose their response- ALWAYS CHECK DRUG CHART ADULT DOSE for Crohns, Ulcerative Colitis,- 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter; treatment with 10 mg/kg IV may be considered for patients who respond and then lose their response- ALWAYS CHECK DRUG CHART Infusion Rates- Inflectra- Infliximab Infusion Infusion Rate Comment Number 1 2 hours - Inflectra- Infliximab Do not administer <2 hours 2 2 hours - Inflectra- Infliximab Do not administer <2 hours 3 2 hours - Inflectra- Infliximab Do not administer <2 hours 4 Reduce to1hr 45minutes 5 Reduce to1hr 30minutes 6 Reduce to1hr 15minutes 7 Reduce to1hr 8+ Continue on 1 hour infusion & If tolerated- reduce at next infusion If not tolerated- go back to 2 hours infusion rates If tolerated- reduce at next infusion If not tolerated- go back to 1hour 45 minutes hours infusion rates If tolerated- reduce at next infusion If not tolerated- go back to 1hour 30 minutes hours infusion rates If tolerated- reduce at next infusion If not tolerated- go back to 1hour 15 minutes hours infusion rates Do not administer <1 hours 6 P a g e

7 Inflectra- Infliximab Infusion Care pathways All clinical staff involved with Infusions should be familiar with how to use an integrated care pathway If you are recording an event, which is predicted by the ICP, then you just sign against that predicted intervention in the column provided. If your intervention is not in line with the pathway, you must record this as a variance in the nursing documentation with the action you will take to try to bring the patient back onto the pathway. Care given by health care assistants and student nurses must be countersigned by a registered nurse. There are many NOTES pages for you to write free text about the care given to the patient by you. These notes should always be dated and timed. All ICP s are chronological so you should be able track the care given very easily OBSERVATIONS REACTIONS * Before Infusion temp. pulse respiration and BP Most anaphylaxis infusion reactions occur in the first 15 Temp, pulse and BP at 15 minutes then half hourly mins, but can occur during the infusion observe during infusion closely. * During Inflectra- Infliximab Infusion visual observation Always call for medical assistance if you are unless unwell when formal observations should continue concerned about a patient. At the end of Inflectra- Infliximab episode temp, pulse and BP * All nurses and doctors should be aware of types and * Baseline set of observations should be done signs of infusion reactions immediately before commencing Infusion and * If a reaction is suspected stop infusion and call for documented on Vital pac * A second set must be done at 15 minutes for ½ hour medical assistance. then ½ hourly and documented on Vital Pac * Medical staff to consider need to administer: * Patients must be advised to inform nurses if they feel Paracetamol 1G, accompanied unwell or have any of the above signs immediately. by Chlorpheniramine (piriton) * If the patient becomes unwell, stop infusion and repeat 10mgs IV. observations. If the observations are abnormal (i.e. temp If no improvement noted, > than 1ºc above baseline and/or sharp increase or drop Hydrocortisone 100mgs IV in pulse or BP) seek medical assistance. If the should be considered. observations are within normal limits repeat after 15 * If there is still no improvement the on-call minutes. If they are still normal but the patient is still Rheumatology Registrar must feeling unwell, seek medical advice / assistance be contacted. * Change the IVI administration set and maintain venous access * Complete an Adverse clinical Incident form PREPARATION and ADMINISTRATION * Only those who have received training in the preparation and administration of Inflectra- Infliximab may administer the infusion * if first Inflectra- Infliximab infusion- Patient to be consented for treatment * Reconstitute each vial with 10 ml of sterile water for injection using a syringe with a 21-gauge needle or smaller. Direct stream to sides of vial. Do not use if vacuum not present in vial. Gently swirl solution by rotating vial to dilute; do not shake. May foam upon reconstitution; allow to stand for 5 minutes. Solution is colourless to light yellow and opalescent; a few translucent particles may develop as infliximab is a protein. Do not use if opaque particles, discoloration, or other particles occur. Withdraw volume of total infliximab dose from infusion container containing 250 ml 0.9% NaCl. Slowly add total dose of infliximab for a concentration ranging from 0.4 to 4 mg/ml. Mix gently. Do not reuse or store any portion of infusion. Use an inline, sterile, non-pyrogenic, low protein-binding filter with 1.2 micron pore size or less * Following infusion 1,2 and 3 the patient to stay in the Rheumatology Day Case Suite for 1/2 hour post infusion 7 P a g e SIGNS TO WATCH FOR Chest pain Abdominal discomfort Flushing Restlessness Palpitations Fever Feeling of doom Rigors Shortness of breath Back pain Hypotension Anxiety CHECKING and SAFETY Either give or if patient has previously been given Inflectra- Infliximab information sheet and answer questions that arise. * Ensure patient understands when to alert staff * Ask patient to state their name and DOB and check the identification band. * Patients who are receiving infusions must be wearing a identification band * Record Infusion Pump Number

8 : Patient Identification Inflectra- Infliximab Day Case Nursing Record Infusion Number 1 Infusion Rate Admitting Nurse Surname First Name of Birth Patients Contact Number Next of Kin Next of Kin contact number Hospital Number Is the Next of Kin aware of Day Case Admission Yes/No If no- please list alternative person to contact in the event of emergency NURSING RECORD Record Signed Cannula insertion recorded on Vital Packs Observation recorded on Vital Packs * Pre Infusion * 15 and 30 minutes into infusion * after 30 minute- records observations 1/2hourly * Infusion Rate- over hours minutes 8 P a g e Discharge Plans Patient to remain 30minutes post infusion Blood Tests Forms provided Discharge Summary complete Yes/No (copy to given to patient Copy of AR UK Inflectra- Infliximab Information Sheet given to patient Patient Advice and Information Line- Leaflet provided If before, during or following the infusion, the patient s blood pressure has been high/low, please advise that they seek follow up with their GP or Practice Nurse also to stay for additional 1 hour until observations stabilise If the patient has felt sleepy or dizzy during the infusion, advise they do not drive or work machinery, to stay for additional 1 hour until observation stabilise If the appointment for infusion has been delayed because the urine test has identified + protein, or + blood or + Nitrite, please advise that they seek follow up with their GP for result of MSU to contact Rheumatology Department following course of treatment If before, during or following the infusion, the patient s blood sugar has been high/low, please advise that they seek follow up with their GP or Practice

9 : Inflectra INFLIXIMAB Infusion Day Patient Identification nurse, also to stay for 2 hours until Blood Sugar levels stabilise Inflectra- Infliximab Day Case Nursing Record Infusion Number 2 Infusion Rate Admitting Nurse Surname First Name of Birth Patients Contact Number Next of Kin Next of Kin contact number Hospital Number Is the Next of Kin aware of Day Case Admission Yes/No If no- please list alternative person to contact in the event of emergency NURSING RECORD Record Signed Cannula insertion recorded on Vital Packs Observation recorded on Vital Packs * Pre Infusion * 15 and 30 minutes into infusion * after 30 minute- records observations 1/2hourly Discharge Plans Patient to remain 30minutes post infusion Blood Tests Forms provided Discharge Summary complete Yes/No (copy to given to patient Copy of AR UK Inflectra- Infliximab Information Sheet given to patient Patient Advice and Information Line- Leaflet provided If before, during or following the infusion, the patient s blood pressure has been high/low, please advise that they seek follow up with their GP or Practice Nurse also to stay for additional 1 hour until observations stabilise If the patient has felt sleepy or dizzy during the infusion, advise they do not drive or work machinery, to stay for additional 1 hour until observation stabilise If the appointment for infusion has been delayed because the urine test has identified + protein, or + blood or + Nitrite, please advise that they seek follow up with their GP for result of MSU to contact Rheumatology Department following course of treatment If before, during or following the infusion, the patient s blood sugar has been high/low, please advise that they seek follow up with their GP or Practice nurse, also to stay for 2 hours until Blood Sugar levels stabilise 9 P a g e

10 : Inflectra INFLIXIMAB Infusion Day Patient Identification Inflectra- Infliximab Day Case Nursing Record Infusion Number 3 Infusion Rate Admitting Nurse Surname First Name of Birth Patients Contact Number Next of Kin Next of Kin contact number Hospital Number Is the Next of Kin aware of Day Case Admission Yes/No If no- please list alternative person to contact in the event of emergency NURSING RECORD Record Signed Cannula insertion recorded on Vital Packs Observation recorded on Vital Packs * Pre Infusion * 15 and 30 minutes into infusion * after 30 minute- records observations 1/2hourly 10 P a g e Discharge Plans Patient to remain 30minutes post infusion Blood Tests Forms provided Discharge Summary complete Yes/No (copy to given to patient Copy of AR UK Inflectra- Infliximab Information Sheet given to patient Patient Advice and Information Line- Leaflet provided If before, during or following the infusion, the patient s blood pressure has been high/low, please advise that they seek follow up with their GP or Practice Nurse also to stay for additional 1 hour until observations stabilise If the patient has felt sleepy or dizzy during the infusion, advise they do not drive or work machinery, to stay for additional 1 hour until observation stabilise If the appointment for infusion has been delayed because the urine test has identified + protein, or + blood or + Nitrite, please advise that they seek follow up with their GP for result of MSU to contact Rheumatology Department following course of treatment If before, during or following the infusion, the patient s blood sugar has been high/low, please advise that they seek follow up with their GP or Practice nurse, also to stay for 2 hours until Blood Sugar levels stabilise

11 11 P a g e