Topic Thread

1.  Who determines infusion durations in your facility?

Posted 06-16-2017 10:18 AM
​Hello.  Who determines/sets the infusion duration for the various medications in your facility?  Nursing currently feels that this should be part of the order coming from the MD, though Pharmacy feels we are in a better position to determine and assign infusion durations.  Just curious how that workflow is in other facilities.

Thank you,

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Laura Akers PharmD
Lead Oncology Pharmacist
Tallahassee Memorial HealthCare, Inc.
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2.  RE: Who determines infusion durations in your facility?

Posted 06-16-2017 02:38 PM
​Just to give insight to our current workflow: MDs prepare the orders but do not specify durations.  PharmD enters the orders specifying durations as outlined in the relevant regimen.  Newer nurse management is wanting to view this as an incomplete order if the MD is not the one stating how long to infuse a medication.  I just want to see which discipline is responsible for this information at other organizations and if you would view an order as incomplete if the MD did not write an infusion duration.  Do the oncologists at your facility defer to pharmacy for this?

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Laura Akers PharmD
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3.  RE: Who determines infusion durations in your facility?

Posted 06-16-2017 04:02 PM
Edited by Ajoke Tijani 06-16-2017 04:50 PM
Pharmacists are responsible for determining infusion times/duration, diluents etc based on regime and/or medications. Unless in certain situations where you can administer either as bolus or CIVI, then this has to be specified on the order.


Thank you,
Ajoke Tijani, PharmD.
SWCC
Lubbock, Texas.





4.  RE: Who determines infusion durations in your facility?

Posted 06-16-2017 04:28 PM
The infusion time should be specified on the physician-signed order and not simply left up to the person entering the order. If an oncology-trained  PharmD "preps" or "writes" the order, as is done in my institution, the duration of infusion will always be specified. As we know, there are important clinical considerations and implications when deciding to give doxorubicin as a 15-minute bolus vs. a 24 or 48-hour infusion, so this should not be decided upon by someone who is not familiar with the particular patient.

The 2016 ASCO/ONS Guidelines for Chemotherapy Administration Safety Standards lists "rate of drug administration, if applicable", as being a requirement of a valid chemotherapy order.

Diluents and volumes are defaulted to our institutional standard and are not always contained on the actual chemotherapy order. A clinician may choose to specify a specific diluent and/or volume on the order, and as long as the requested diliuent and/or volume is compatible and safe, this will be entered (diabetic pts with NS rather than D5W, pts. requiring minimal fluids, etc.).

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Bonnie A. Labdi, PharmD

Clinical Pharmacy Specialist
Hematology/Oncology
Memorial Hermann Cancer Center – TMC

Clinical Assistant Professor
Department of Internal Medicine – Oncology
The University of Texas John P. and Katherine G. McGovern Medical School at Houston

6400 Fannin Street, Suite 2900
Houston, TX 77030
Office: 713-704-3136
Fax: 713-704-3085
E-mail: Bonnie.Labdi@MemorialHermann.org
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5.  RE: Who determines infusion durations in your facility?

Posted 06-19-2017 08:48 AM
​Our providers believe the pharmacists are much more knowledgeable regarding infusion rates and leave that up to us....our docs are very appreciate of everything we can and will do for them!

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Sharyn Foster, RPh MBA
Foundation Oncology Pharmacy Manager
Nashua NH
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6.  RE: Who determines infusion durations in your facility?

Posted 06-19-2017 11:09 PM
In my institution, it's the pharmacist Who determines the rate, duration, diluents and sequence of administrations which are all included in our order template which I designed. One of our oncologists does not use our order templates but he writes in his orders that the rate and diluents is determined by the pharmacist.

Mellissa Taylor

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Mellissa Taylor
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