Policy Manual sample

MDT Home Health Care Agency, Inc. 153 • If the patient has a history of allergy to the prescription drug, it must be changed to an appropriate alternate to minimize risk of anaphylaxis. Note: Prior exposure may have sensitized the individual; subsequent doses can elicit an allergic response. • A physician's plan of treatment must include an order which states, "first dose of __________________ to be administered in the home", the dose, route, rate of administration, any pretreatment or preinfusion lab work, emergency protocol, specific parameters for adverse drug reaction, postinfusion monitoring and physician's location and phone number during initial infusion. • An anaphylaxis kit must be readily available per a physician's order during the entire infusion. A kit will typically contain, but is not limited to: • Adult:  One (1) administration set  Two (2) 21 g butterfly  One (1) 90 mm airway  Two (2) tongue blade (for airway insertion)  One (1) 0.3 mg EpiPen-Injector  Two (2) epinephrine 1:1000 (IM)  One (1) diphenhydramine (Benadryl) 50 mg per mL IV, IM or PO  Six (6) prep pads  Three (3) pairs gloves  One (1) D 5 W 500 mL • Pediatric:  One (1) microdrip set  Two (2) 23 g butterfly  One (1) 60 mm airway  Two (2) tongue blade (for airway insertion)  One (1) 0.15 mg EpiPen Junior Injector