Pediatric Nurses Fill a Gap in Infusion Services

Nurses on the outpatient pediatric hematology/oncology unit at Cleveland Clinic’s main campus are experts at providing infusion therapy. They regularly infuse patients that receive chemotherapy, monoclonal antibodies and other treatments. “That keeps us incredibly busy,” says nurse manager Kristen Powaski, BSN, RN, CPHON.

But in the past year or so, the five full-time and two part-time nurses on the unit have become even busier – by choice. They offered to provide infusion services for other medical specialties, starting with rheumatology and expanding to genetics, neurology, cardiology and nephrology. “There are not a lot of other options for pediatric infusions aside from a small clinic in one of our community health centers and a clinic on main campus,” says Powaski. “And those were working at capacity, so people were searching for other options.”

Handling adverse reactions

Johannes Wolff, MD, in the Pediatric Hematology Oncology and Blood and Marrow Transplantation Department at Cleveland Clinic’s main campus praises the nurses for increasing infusion services. “Those nurses decided to take it on, and that’s quite a big deal,” says Dr. Wolff. “Those patients are not their primary patients. They took on difficult infusions from other disciplines.”

One of the biggest groups now served is patients with inherited enzyme deficiencies who require enzyme infusions on a regular basis, says Dr. Wolff. Such infusions are complicated, with a risk of allergic reactions. But nurses on the hematology/oncology unit are adept at handling complication infusions.

“Our nurses have a very high attention to detail, are specially-trained in infusion therapy and can handle adverse reactions that may occur,” says Powaski. Those reactions may include rash, fever, cough or full-blown anaphylaxis.

Keeping patients out of the hospital

Patients require very close monitoring, including checking vital signs every 15 to 30 minutes. And many of the therapies – such as intravenous immunoglobulin (IVIG), enzyme therapies and monoclonal antibody therapies – can take up to seven hours or so. Powaski says that the volume of infusions requiring frequent monitoring has increased by 61 percent.

To accommodate the increase in infusion services, nurses on the hematology/oncology unit now offer infusion therapies three days a week. Previously, infusions were done once a week. “It certainly has been a challenge because the same number of staff are handling this increased volume,” says Powaski. “But we are working on that. And our team works incredibly well together. Everyone pitches in whenever necessary.”

Ultimately, the nurses are willing to go the extra mile to put patients first. They understand the value in providing infusion services in an outpatient setting. “If we can keep patients out of the hospital and give them more time at home, that’s a good thing for both the patient and the hospital,” says Powaski. “It saves time, lowers costs and provides quality care.”