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A home care nurse visited a patient to change his pump cassette and reset his ambulatory infusion pump for a newly prescribed concentration of fluorouracil, an anticancer drug. She reprogrammed the pump incorrectly. Within 24 hours, the patient received a 5-day supply of the drug. He began vomiting repeatedly and eventually developed leukopenia. Luckily, he recovered.
Home I.V. therapy requires extra precautions. A patient at home won't receive the same close monitoring he would in the hospital. So you have to be especially vigilant when manipulating infusion control devices. Plus, the drugs commonly infused with ambulatory pumps-such as anticancer drugs, I.V. narcotics, and other critical care drugs-warrant special attention.
At least two people should check pump settings or changes to make sure the device has been programmed correctly. For example, when you know you're going to change a setting, you could ask the pharmacist for a pump that's set properly before you leave for the patient's home. Once there, you would change the pumps, returning the old one to the pharmacist.
Or, if the doctor orders a change while you're at the patient's home, you can calculate the dosage and setting change, then call the pharmacist or another home care nurse. During your call, you would review and verify the steps you've taken to reprogram the pump. As an extra precaution, you could read the pump settings from the LED screens.
You should also teach the patient what the settings should be.
If he notices that they're off, he can alert you before a problem develops. But make sure the lockout feature is activated so the patient can't inadvertently change the settings.
These steps could drastically reduce the risk of harming a patient with an erroneous ambulatory pump setting.