I have been working in my facility for over 3 yrs. it is a small 3 chair output infusion unit in a hospital setting. We include chemotherapy in our service as well as antibx,biologics,blood transfusions etc.
We are certified in chemotherapy. One thing has always nagged at me. Our unit does not have a medical director. We do not have a doc present in our unit. I have been told that the ER docs are our technical coverage. We have been visited by jacoh and state. When I attend other conferences I have been told a MD needs to be present when procedures and therapies esp chemo are done. I always worry we are not really kosher. So far nothing has happened to test the issue. Who do I ask? Do any of you work in a similar type of unit?
Some thoughts.
If you are located within the physical hospital, technically a doctor (ER for instance)/ medical director is on site/ designated.
Think about other departments, not every ICU has a physician present at all times, but have available physicians to respond as needed.
A medical director sounds like a great idea to guide your practice and identify your medical resources. Do the prescribing doctors make themselves available to you?
There are many outpatient stand alone infusion clinics without on site physicians. They have policies to manage emergencies and emergency services (911) for back up. You should also have such policies and emergency protocols.
Who oversees your dept? Who do you report to or ask for help? Did JC or the State ever mention they wanted to see a physician involvement with your dept> they would have commented if there were concerns.
I have given chemo in all sorts of settings and under normal circumstances I was never instructed that a physician's presence was needed. If a concern was raised regarding a treatment, the patient was not infused in an alterntive setting.
Ann
Ann Zonderman, BSN, JD, CRNI
I agree with Ann. I have given rivers of chemo all inside community based hospitals, long before there was such a person as an intensivist. If there was a problem, our only physician backup was through the ED. You must have written protocols to manage events but that is an acceptable method of practice. I always have strong reservations anytime someone talks about requiring a physician to oversee nursing practice. Nursing practice and medical practice is quite different. Each have an independent domain, a dependent domain, and an interdependent domain. You just have to figure out what situations may occur where written medical protocols may be needed, and then get those written and approved. Realize that the administration of chemotherapy and nursing management of many events or completely within nursing's independent domain. Be able to identify the differences. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you for input. We do have policies in place and feel we give excellent nursing care. I often feel patients get more individualized care in our small unit and we can contact Drs as needed.
Carolyn