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1 to 1 staffing

  • 1.  1 to 1 staffing

    Posted 08-06-2019 19:14
    ​​Our clinic is looking at staffing ratios and a question came up about what other outpatient clinics are doing with those infusions that have a high risk of reaction?  Are you 1 to 1 with that patient during the first infusion, if so how long do you stay at their bedside or chairside?  What drugs are you staying with the patients?

    We have a fairly small clinic with 13 chairs, most of them are visible from our nurses station.  We, at this time, are not at chairside unless we are checking vitals, educating, etc.

    Your responses will be greatly appreciated!

    Deb

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    Deborah Hurst RN OCN
    William S. Middleton Memorial VA Hospital
    Madison, WI
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  • 2.  RE: 1 to 1 staffing

    Posted 08-07-2019 10:22
    ​We also have a small infusion area with decent visibility of patients. We do not generally utilize an acuity tool for staffing, however, but have started to try to look further into it. I'm not sure if it helps, but here's a tool that is in the works. I have not found any national benchmarks for this.

    Acuity Tool

    IV and Subcutaneous Chemotherapy-Related Treatments

    Examples

    1

    ·         Subcutaneous Chemotherapies/Injections

    ·         Stand-alone Hydration

    ·         Non-chemo single dose infusions

    ·         De-access Mediport/Flush

    ·         PIV SIM Start

    ·         Lupron, SQ Velcade, Neupogen, Neulasta, Aranesp

    ·         Zometa, Venofer

    ·         Vidaza

     

    2

    ·         CHEMOTHERAPY with low risk of reaction

    ·         Connect or change of continuous infusion chemotherapy pump

    ·         Single agent Chemotherapy Infusions

     

    ·         Nivolumab, Decitabine, Carfilzomib, Day # 2/3 ETOP,

    ·         5FU continuous infusion (x5 or 7 days)

    ·         Gemzar, Herceptin, Abraxane, Taxol, Alimta, etc….

     

    3

    ·         Single Agent IVP Chemotherapy

    ·         Second Subsequent Infusions of possibly reactive CHEMOTHERAPY (single agent)

    ·         2 Chemo agents in one treatment regimen

    ·         IV Velcade, Navelbine, AC, CARBO/ETOP(DAY #1), Taxol/Herceptin, Rituxan, IVIG, Carbo/Taxol, Daratumumab, Carboplatin, Doectaxel, Paclitaxel,

    ·         low dose Cisplatin <50mg/m2

    4

    ·         DAY #1(first) Infusions of a Chemotherapy with potential for reaction - ONLY

    ·         3 Chemo agents in one treatment regimen

    ·         Gem/Abraxane, Carbo/ETOP, First Dose Rituxin/Docetaxel/Paclitaxel, obintuzamab, pembrolizumab, carbo/taxol/avastin, pertuz/traztuz/taxol

    ·         High Dose Cisplatin >50mg/m2

    5

    ·         4-5 chemotherapy drugs in one treatment

    ·         Re-challenge of any patients post-reaction to any chemotherapy infusions

    ·         FOLFOX alone (no medication)

    ·         RCHOP, RICE, FOLFOX etc….

    ·         Rechallenge of any drug after reaction

    6

    ·         FOLFIRINOX- FOLFOX and any additional chemotherapy

    ·         Omaya

    ·         FOLFOX/AVASTIN, FOLFIRI, FOLFIRINOX, additional drugs as Cetuximab. Omaya Chemo Administration

    Add 1 additional point

    ·         Need interpreters/Increased level of Care/Poor Access

    ·         Additional electrolyte replacement

    ·         Multi-dose injections

    ·         Neulasta OnPro

     

    ·         Decreased Mobility/Social or Behavioral Concerns

    ·         Chemo Teaching First Dose

    Acuity should be 16 per RN and additional nurse over 32


    -Jenny

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    Jennifer Coutu, MSN, RN, OCN
    Ellington CT
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