BOSTONOutpatient infusion units around the country have
experienced soaring numbers of patients due to changes in reimbursement as
well as increasingly complex cancer treatments. In a move that contributed
to this growth, oncologists at the Massachusetts General Hospital (MGH),
supported by the literature, began giving 2-hour infusions of pamidronate
(Aredia®) for prevention of skeletal complications from several
At the MGH Cancer Center Infusion Unit, where the number of patient
visits increased by an average of 22% in 4 years, Joanne Perri-LaFrancesca,
RN, MN, nurse manager, and her staff came up with one solution to deal with
the long patient waits that resulted from this growth: ambulatory pumps for
cancer patients receiving pamidronate.
Ms. LaFrancesca, Joan M. Agretelis, PhD, RN, and Susan Sheehan, RN,
presented a description of the ambulatory infusion program at a poster
session of the Oncology Nursing Society’s 26th Annual Congress.
Patient waits for infusion occurred for many reasons other than increased
volume, Ms. LaFrancesca noted. "Because we are a large city hospital,
we have issues with parking and transportation in and out of the city,"
she said. "Patients prefer midday appointments to avoid Boston’s
notorious traffic and transportation problems."
In addition, she said, the physicians have commitments early and late in
the day requiring that patient care activities take place in the middle of
the day. "This all added up to a midday crunch," Ms. LaFrancesca
said in an interview with ONI.
The infusion unit, with 10 beds and 14 chairs, has approximately 2,000
visits monthly and continues to grow. "We had all these patients coming
in at the same time, and we were seeing horrifically long waits. I didn’t
know what to do about it," she said.
Since the patients receiving pamidronate were occupying chairs for 2
hours, Ms. LaFrancesca and her staff came up with an idea: If the first dose
of pamidronate was tolerated without difficulty, then on subsequent visits,
patients could opt to have an ambulatory infusion pump and leave the
infusion unit. In this way, the space could be used for another patient who