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Infusion Center Drug Reaction – Adult - Inpatient/Ambulatory [11]

Infusion Center Drug Reaction – Adult - Inpatient/Ambulatory [11] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols

Delegation Protocol Number: 11

Delegation Protocol Title:
Infusion Center Drug Reaction – Adult – Inpatient/Ambulatory

Delegation Protocol Applies To:
UW Health Infusion Centers

Target Patient Populations:
Any adult patient receiving a drug infusion at UW Health Infusion Centers

Delegation Protocol Champions:
Edward Lalik, DO – Department of Medicine – Hospitalists
David Hei, MD – Department of Medicine-Hematology/Oncology

Delegation Protocol Reviewers:
Noreen Hogan, RN – Infusion Center
Dawn Berndt, MSN, BSN, Manager, Infusion Center
Heather Schrant, MS, PharmD – Pharmacy Manager
Julie Nampel, MSN, RN, NE-BC – Manager, Oncology Clinics

Responsible Department:
UW Health Infusion Centers
Department of Pharmacy

Purpose Statement:
To delegate the authority from the UW Health provider ordering medications or treatments for
administration at a UW Health infusion site to Registered Nurses (RNs) and pharmacists to enter infusion
reaction treatment orders in Health Link and to intervene in a safe and consistent manner for patients
experiencing a drug reaction in the UW Health Infusion Centers.

Who May Carry Out This Delegation Protocol:
Registered Nurses (RNs) and pharmacists in the UW Health Infusion Center trained in the use of this

Guidelines for Implementation:
1. This protocol is initiated when a patient is scheduled to receive a medication infusion or treatment in a UW
Health Infusion Center but for whom the provider has not ordered specific treatment for a potential
reaction. The pharmacist will proactively enter orders for infusion reaction treatment using the standard
therapy plan or order sets (see collateral tools).
2. If the patient shows signs of an infusion reaction such as skin and/or mucosal changes (flushing,
angioedema, urticarial), pharyngeal/laryngeal edema, hoarse voice or strider, or patient anxious and
experiencing a “sense of impending doom”, the RN will stop the infusion and reassess the patient.
2.1. If the patient has an inadequate response to termination of the infusion, the RN will administer the
reaction medications and oxygen as ordered.
2.2. The RN will initiate the most optimal position for the patient’s condition and assess the patient’s oxygen
saturation with pulse oximetry.
2.3. The RN will continue to monitor the patient’s oxygen saturation, blood pressure and pulse until the
patient’s condition returns to baseline.
3. The RN will contact the ordering provider via page that the Infusion Center Drug Reaction – Adult –
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:

Inpatient/Ambulatory delegation protocol has been initiated.
3.1. University Hospital-based Infusion Centers - If the ordering provider is unreachable, the Consult
Hospitalist we be contacted via pager #6699 with an FYI that the Infusion Center Drug Reaction – Adult
– Inpatient/Ambulatory delegation protocol has been initiated for an infusion reaction. There will be a
follow-up page to the same provider 5-10 minutes after administration of reaction medications in the
form of an FYI stating the patient has improved or in the form of STAT indicating the provider is to
evaluate the patient in the Infusion Center.
3.2. Clinic-based Infusion Centers – If the patient dose not respond to stopping the infusion and
administration of the reaction medications, the RN will follow the clinic’s emergency response
5. The infusion will not be restarted until the original prescriber, or the covering provider designated
in the original order, is consulted. The provider will discontinue the order for the offending medication,
agree to a challenge of the offending medication, or provide further instruction. If the offending medication
was originally ordered via an approved UW health order set which includes specific instructions for re-
challenge in the event of an infusion reaction, the orders from the order set can be followed without
contacting the original prescriber.

Order Mode:
Medications: Protocol/Policy, Without Cosign
Non-Medications – Cosign Required, Protocol/Policy

1. Soar J, Humphrey R; Cant a, et al. Emergency treatment of anaphylactic reactions: guidelines for
healthcare providers. Working Group of the Resuscitation Council. 2008; 1-50.
2. Soar J, Emergency treatment of anaphylaxis in adults: concise guidance. Clin Med 2009; 9(2): 181-5.
3. Gahart & Nazareno: Intravenous Medications, 26
ed., 2009.
4. Hodgson & Kizior: Saunders Nursing Drug Handbook 1
ed., 2010.
5. Nurmatov U, Anaphylaxis management plans for the acute and long-term management of
anaphylaxis: a systematic review. J Allergy Clin Immunol 2008; 122(2): 353-61.
6. Kemp AS, New action plans for the management of anaphylaxis. Aust Fam Physician 2009; 38(1- 2): 31-5.

Collateral Documents/Tools:
1. IP/OP – Drug Reaction – Infusion Center – Adult - Supplemental [3054] order set

Approved By:
UW Health Ambulatory Protocol Committee: October 2014; *August 2017
UWHC Pharmacy and Therapeutics Committee: November 2014; *August 2017
UWHC Medical Board: November 2014; *August 2017
UW Health Chief Medical Officer: November 2014; *August 2017

Effective Date: August 2017

Scheduled for Review: August 2020
*Expedited Review Process
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: