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Supporting Safe Home Discontinuation of Infusors™ for BC Cancer Agency Patients
(Read more about the Infusor Home Discontinuation Process for Patients or Caregivers)
Background:
Between April 2007 and March 2010 there was a 36% increase in the number of patients receiving ambulatory infusional chemotherapy at BCCA Regional Cancer Centers. 838 patients were treated using Baxter Infusors™ last year, and 6567 Infusors™ were dispensed to those patients.
At the end of each ambulatory continuous infusional treatment, the empty Infusor™ must be disconnected (dc) and disposed of, and the patient’s central line flushed to maintain patency. Typically, this has required a scheduled visit to a cancer center, hospital, or chemo unit, or a visit to the patient’s home by a Home Care nurse.
Travel to a cancer center, parking and waiting can be costly. As well, patient’s energy levels are compromised by this process. In all centers except Vancouver, treatment start days for infusional chemotherapy are limited to Monday through Wednesday because the patient needs to return to the clinic for dc on a weekday.
The option of requesting that a Home Care nurse discontinue the Infusor™ in the patient’s home is becoming increasingly challenging because of community nursing staff shortages. Home Care can no longer support this procedure in some health authorities. As well, it is difficult for the Home Care nurse to schedule a visit that coincides with Infusor™ completion time.
The increase in numbers of ambulatory infusional treatments delivered poses new challenges to the care system and an opportunity to consider safe alternative approaches. In the past 3 years, several steps have been taken to increase the efficacy and safety of infusional chemotherapy in hospital and at home. FVC RNs Seana Hutchison and Shelley Dick trialed a program at their center to support patients to have their Infusors™ discontinued and their venous access devices flushed by a caregiver (non-health care professional) at home.
This trial program ran between April and August 2008, and aimed to determine if the expressed concerns related to the potential for increased infection or occlusion rates were justified.
The results showed that there was no increase in the incidence of catheter occlusions and infection in those patients whose devices were discontinued at home. Moreover, patients identified the following as key advantages of the home dc process: less travel time, increased independence, increased self control and energy savings. They also appreciated feeling less of a “burden”, and being able to maintain a normal “worklife”. They did not express being worried/concerned about the discontinuation process. All stated they would participate in the project again.
Conclusion:
Infusional chemotherapy treatments can be safely discontinued at home by the patient or a caregiver provided the following key elements are in place:
Thorough assessment process to determine if patient/caregiver is able to perform the procedure at home.
System to provide necessary supplies for the procedure.
System to order and dispense prescription medication (Heparin) to patient.
Scheduled session to teach caregiver to perform procedure.
Backup system to support caregivers/patients experiencing difficulties with the procedure or device at home.
The Home DC Program has now been formalized to clarify the steps to be taken in every regional cancer center to support safe discontinuation of Infusors™ at home.
1. Assessment of supports and ability
When discussing the insertion of the venous access device before treatment, the oncologist will inform the patient of the home discontinuation process.
Each patient who is to receive infusional chemo will be assessed for ability to have home discontinuation of their infusional chemo performed by themselves or by a caregiver who is not a health care professional.
The individual performing the home discontinuation must:
o Be willing to be available at the expected time of DC.
o Be willing to attend one 30 minute teaching session (booking code TEACHINF) with an RN at a regional cancer center.
o Have the manual dexterity to perform skill.
o Be able to demonstrate the discontinuation procedure to the nurse.
o A patient whose caregiver experiences difficulty/is not comfortable with the home dc process will have that procedure performed in the regional center.
2. Provision of Equipment and Supplies:
All equipment required to perform the procedure will be packaged up into a kit at the regional center. The CNC will describe the location of the kit and who will prepare the kits for use.
The patient will receive a kit at the teaching session.
Kits will be replenished every 4 cycles with sufficient supplies for 4 cycles.
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KIT CONTENTS FOR HOME DC OF INFUSOR™
4- Ziploc bags, chemo weight
4 -Blue pads
4 prs chemotherapy approved gloves
4 - PFS 0.9% normal saline x 20 mls
12 Alcohol swabs
4 - Bandaids (IVAD)
4 - 2” x 2” sterile gauze swabs
4 - Intermittent injection caps (PICC)
1 - Cytotoxic Waste Container Waste container with capacity for 4 infusors (returned to center for disposal after 4 treatments for when full)
1 - Pamphlet: Safe handling of chemotherapy at home
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3. Ordering and Dispensing Heparin.
- Preprinted prescription pads will be available for physicians ordering Heparin for line flushing.
- The physician will sign a Pre-Printed prescription for heparin.
- The patient will fill the prescription at a community pharmacy.
4. Teaching session
- The patient and support person will be booked to a teaching session of 30 minutes (TEACHINF) on the day of the first discontinuation.
- A CVC certified RN will teach a family member/caregiver to dc as per the related Patient Teaching Standard for Discontinuing Infusor™ from IVAD or PICC.
These standards are Appendices 8 and 9 in Nursing Practice Reference C-252.
- The RN will provide the patient with Patient Teaching Sheets: Discontinuing an Infusor™ from an IVAD or PICC. http://www.bccancer.bc.ca/HPI/DrugDatabase/DrugIndexPt/INFUSOR™+-+IVAD.htm or
These sheets are linked to each ambulatory continuous infusional chemotherapy protocol under Available Documents.
- The RN will include and emphasize the contact numbers for 24 hour support if the patient or caregiver encounter problems with managing or discontinuing the Infusor™.
5. Backup system
- If a patient is not deemed suitable for home discontinuation by a caregiver, bookings will be made to the outpatient department or to Home Care for this procedure.
For further information about this initiative please contact Judy Oliver at: joliver@bccancer.bc.ca