Cyclophosphamide INFUSION Infusion 4 Plus

Transcription

1 Cyclophosphamide Infusion Day DEPARTMENT OF RHEUMATOLOGY DAY CASE ADMISSION RECORD PATIENT DAY CASE BOOKING REQUEST To be completed by Consultant, Registrar requesting day case Admission Hospital No. Forename Address Cyclophosphamide INFUSION Infusion 4 Plus Post Code SPECIAL INSTRUCTION FROM CONSULTANT/ REGISTRAR Telephone Number Reason for Day Case Cyclophosphamide 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 Patient Identification Label First Name Hospital Number Cyclophosphamide Infusion Day 2 P a g e

3 Patient Identification Label First Name Hospital Number Cyclophosphamide Infusion Day 3 P a g e

4 Patient Identification Label First Name Hospital Number Cyclophosphamide Infusion Day 4 P a g e

5 Cyclophosphamide Infusion Day Blood Tests- results HB WBC- Contraindicated- White cell count <4 x 10 9 /L Platelets-Contraindicated- Platelet count <100 x 10 9 /L Neutrophils ESR Urea Sodium Potassium Creatinine- contraindicated- Creatinine >120umol / L * Albumin Alk phosphatase Contraindicated if >3 normal for patient Total Protein Bilirubin- Contraindicated Bilirubin >17umol / L * AST- Contraindicated if >3 normal for patient CRP Actions-Blood Results Date Action Date Date Date Print Signature Discussed with Actions-Blood Results Date Action Print Signature Discussed with Actions-Blood Results Date Action Print Signature Discussed with 5 P a g e

6 Cyclophosphamide Infusion Day Urine Tests- results Date Date Date Nitrate Protein Leukocyte Blood Actions-Urine Results Date Print Signature Discussed with Actions-Urine Results Date Print Signature Discussed with Actions-Urine Results Date Print Signature Discussed with IMPORTANT CONTACT NUMBERS Action If >+ Protein, nitrite or patient symptomatic of UTI, please send MSU Discuss with Doctor D/W Doctors if evidence of Blood- awareness of Action If >+ Protein, nitrite or patient symptomatic of UTI, please send MSU Discuss with Doctor D/W Doctors if evidence of Blood- awareness of Action If >+ Protein, nitrite or patient symptomatic of UTI, please send MSU Discuss with Doctor D/W Doctors if evidence of Blood- awareness of Rheumatology Nurses Bleep 1780 Rheumatology SHO Day Case Coordinator Ext 6176 Rheumatology SpR 6 P a g e Bleep 1351 RGH/RS Bleep 1068 SAY/FCM/ANC Bleep 1354 EW/JML bleep 1355

7 Cyclophosphamide Infusion Day Patient information check list- to be completed by nursing staff Please record Infusion Number Infusion Infusion Infusion Date:- Has the patient previously had a Cyclophosphamide Infusion If yes, did the patient experience any side effects during or immediately after or following discharge 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 Cyclophosphamide 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 Digestive Tract- abdominal pain, change in bowel habit Other Type Has the patient experienced any signs of Haemorrhagic cystitis -sudden onset of hematuria combined with bladder pain and irritative bladder symptoms etc:- Has the patient received any form of Vaccination in day leading up to Cyclophosphamide Infusion Is the patient a Diabetic If yes please check blood sugar prior to Abatacept If Blood Sugar result> 7 Female Patients- Is the patient currently pregnant Male Patients- has the patient recently fathered a child with partner If the patient has felt sleepy or dizzy during previous s, advise that they do not drive or work machinery Has the patient commenced any new medication since last appointment with Rheumatology Department Blood Sugar Blood Sugar Blood Sugar 7 P a g e

8 Cyclophosphamide Infusion Day Please record Infusion Number Infusion Infusion Infusion Date:- Patient Orientated to Day Case Suite Toilet/ Refreshments/ Magazines et Has the patient recently been investigated for a cancer Is the patient about to have or had recently any surgical procedures Has the patients general state of health changed since appointment with Rheumatology Department Has the patient had any recent cardiac events, uncontrolled hypertension or angina Has the patient any ankle oedema or breathlessness 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 Side Effects These should be discussed with the patient and relatives BEFORE treatment: Nausea and vomiting. Haemorrhagic cystitis. Depression of bone marrow maximal at 10 days. FBC in 10 days post. Alopecia (most people can expect a degree of hair thinning which invariably re- grows. Early Menopause Permanent bladder fibrosis (rare). Cardio toxicity (rare). Long-term malignancy (?%). All other DMARDS (e.g. Methotrexate, Azathioprine) stopped for Pulse of Cyclophosphamide unless expressly specified by Consultant If no, discuss with Doctor prior to Any signs of dehydration- if yes document in nursing notes and please d/w with doctor Encourage patient to drink at least a total 3000mls fluid during the following 24hours If Yes, discuss with Doctor prior to Other issues discussed during the day case admission related to Cyclophosphamide Infusion If yes please document in Nursing Notes Patient consented- prior to first Cyclophosphamide Patient to report Pain along the vein - If this happens, patient to inform the nurse straight away. Infusion Pump Number Cyclophosphamide Batch Number 8 P a g e

9 Cyclophosphamide Infusion Day Cyclophosphamide 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 Before Infusion temp. pulse respiration and BP Temp, pulse and BP at 15 minutes then half hourly during During Cyclophosphamide Infusion visual observation unless unwell when formal observations should continue At the end of Cyclophosphamide Infusion episode temp, pulse and BP * Baseline set of observations should be done immediately before commencing Infusion and documented on Vital pac * A second set must be done at 15 minutes for ½ hour then ½ hourly and documented on day case on Vital pac * Patients must be advised to inform nurses if they feel unwell or have any of the above signs immediately. * If the patient becomes unwell, stop and repeat observations. If the observations are abnormal (i.e. temp > than 1ºc above baseline and/or sharp increase or drop in pulse or BP) seek medical assistance. If the observations are within normal limits repeat after 15 minutes. If they are still normal but the patient is still feeling unwell, seek medical advice / assistance PREPARATION and ADMINISTRATION * Only those who have received training in the preparation and administration of Cyclophosphamide may administer the * if first Cyclophosphamide - Patient to be consented for treatment REACTIONS Most anaphylaxis reactions occur in the first 15 mins, but can occur during the observe closely. Always call for medical assistance if you are concerned about a patient. * All nurses and doctors should be aware of types and signs of reactions * If a reaction is suspected stop and call for medical assistance. * Medical staff to consider need to administer: Paracetamol 1G, accompanied by Chlorpheniramine (piriton) 10mgs IV. If no improvement noted, Hydrocortisone 100mgs IV should be considered. * If there is still no improvement the on-call Rheumatology Registrar must be contacted. * Change the IVI administration set and maintain venous access * Complete an Adverse clinical Incident form * Following 1,2 and 3 the patient to stay in the Rheumatology Day Case Suite for 1/2 hour post Extravasation- Pain along the vein -If this happens, tell Stop Infusion and follow trust extravasation policy. If no evidence of extravasation- slow the drip to ease the pain Signs to look out for:- a rash feeling itchy, flushed or short of breath swelling of your face or lips feeling dizzy having pain in your tummy, back or chest feeling unwell. CHECKING and SAFETY Either give or if patient has previously been given Cyclophosphamide 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 s must be wearing a identification band * Record Infusion Pump Number 9 P a g e

10 Date: Cyclophosphamide Infusion Day Cyclophosphamide Infusion Day Case Suite Patient Identification Infusion Number Infusion Rate Admitting Nurse First Name Patients Contact Number Next of Kin Next of Kin contact number Hospital Number Is the Next of Kin aware of Day Case Admission If no- please list alternative person to contact in the event of emergency NURSING RECORD Date Record Signed Cannula insertion recorded on Vital Packs Observation recorded on Vital Packs * Pre Infusion * 15 and 30 minutes into * after 30 minute- records observations 1/2hourly 10 P a g e Discharge Plans Patient encouraged to drink at least 3litres during the next 24hours Patient to remain 30minutes post Blood Tests Forms provided- Patient to have blood test- 10days post Discharge Summary complete (copy to given to patient Copy of AR UK Cyclophosphamide Information Sheet given to patient Patient Advice and Information Line- Leaflet provided If before, during or following the, 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, advise they do not drive or work machinery, to stay for additional 1 hour until observation stabilise If the appointment for 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, 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 If before, during or following the, 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 Date: Cyclophosphamide Infusion Day Cyclophosphamide Infusion Day Case Suite Patient Identification Infusion Number Infusion Rate Admitting Nurse First Name Patients Contact Number Next of Kin Next of Kin contact number Hospital Number Is the Next of Kin aware of Day Case Admission If no- please list alternative person to contact in the event of emergency NURSING RECORD Date Record Signed Cannula insertion recorded on Vital Packs Observation recorded on Vital Packs * Pre Infusion * 30 minutes into * Prior to Discharge 11 P a g e Discharge Plans Patient encouraged to drink at least 3litres during the next 24hours Patient to remain 30minutes post Blood Tests Forms provided- Patient to have blood test- 10days post Discharge Summary complete (copy to given to patient Copy of AR UK Cyclophosphamide Information Sheet given to patient Patient Advice and Information Line- Leaflet provided If before, during or following the, 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, advise they do not drive or work machinery, to stay for additional 1 hour until observation stabilise If the appointment for 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, 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 If before, during or following the, 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

12 Date: Cyclophosphamide Infusion Day Cyclophosphamide Infusion Day Case Suite Patient Identification Infusion Number Infusion Rate Admitting Nurse First Name Patients Contact Number Next of Kin Next of Kin contact number Hospital Number Is the Next of Kin aware of Day Case Admission If no- please list alternative person to contact in the event of emergency NURSING RECORD Date Record Signed Cannula insertion recorded on Vital Packs Observation recorded on Vital Packs * Pre Infusion * 30 minutes into * Prior to Discharge 12 P a g e Discharge Plans Patient encouraged to drink at least 3litres during the next 24hours Patient to remain 30minutes post Blood Tests Forms provided- Patient to have blood test- 10days post Discharge Summary complete (copy to given to patient Copy of AR UK Cyclophosphamide Information Sheet given to patient Patient Advice and Information Line- Leaflet provided If before, during or following the, 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, advise they do not drive or work machinery, to stay for additional 1 hour until observation stabilise If the appointment for 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, 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