July 1, 2008

How Does Your Infusion Room Function?
Liz Akar, RN, OCN^®, Bend, OR

Every day we are filled to capacity. We are a small, outpatient clinic with four oncologists and a nurse practitioner. We seat 14, with a bedroom for the more complicated, higher acuity folks. Our scheduler does a good job, but we are constantly faced with add-ons, walk-ins, and cancellations and cannot predict the day’s flow nor seem to stay steady throughout the day.

How do other infusion rooms balance the flow? Our manager requires us to take lunches, but sometimes that’s not possible. We try to accommodate family but sometimes have to ask them to wait in the lobby until it’s less hectic. At the end of the day, the place looks like a hurricane hit, yet we love coming back and doing it all over again. It’s the patients that bring us joy and reward us with their kindness (and cookies!).

Do the RNs compound? How much autonomy do you have during an infusion reaction? I remember the days when paclitaxel before carboplatin was the only orderly chemotherapy we needed to follow! For your FOLFIRIs, are you running the irinotecan for 90 minutes concurrently with 90 minutes of leucovorin? When you have high-dose cisplatin/docetaxel, do you pre-med, fluid, cisplatin, fluid, docetaxol? Or do you pre-med, fluid, cisplatin, docetaxel, fluid? Or do you depend on the physician to list the order the drug is to be given? Those types of questions come up every day, and sometimes we cannot find the answers in the package insert nor National Comprehensive Cancer Network guidelines.

I want to know how other infusion rooms function. How many clinics have a shot clinic? How can we minimize waste? Hypothetically, if all the gemcitabine patients came on the same day, we’d have enough left over to “feed the poor”!

Click here to post a response to Liz’s questions.