ABSTRACT
Although many pharmaceutical companies have programs that provide prescription medications to medically uninsured or underinsured patients, many health-care providers have not taken full advantage of the programs for a variety of reasons. In an effort to offset the escalating costs of medications for this group of patients, one public teaching facility developed a program to better utilize pharmaceutical patient-assistance programs. Resources are described, including Web sites and available publications, that may improve utilization of assistance programs. Eligibility criteria and enrollment procedures for specific drug reimbursement programs are included. Enrollment of medically underinsured or uninsured patients into medication-assistance programs can produce significant savings that benefit patients and institutions. Healthcare providers must examine all avenues to provide medications to the medically uninsured.
Subject(s)
Hospitals, Public/organization & administration , Hospitals, Teaching/organization & administration , Medical Assistance/statistics & numerical data , Medically Uninsured , Pharmaceutical Preparations/supply & distribution , California , Drug Costs , Drug Industry/organization & administration , Eligibility Determination , Female , Humans , Internet , Middle Aged , United StatesABSTRACT
PURPOSE/OBJECTIVES: To review the phenomenon of thromboembolism in patients with cancer, discuss treatment options for deep vein thrombosis (DVT), and describe oncology nurses' role. DATA SOURCES: Published articles, abstracts, professional communications, drug manufacturer information, and personal clinical experience. DATA SYNTHESIS: The incidence of DVT in patients with cancer can be as high as 15%. The cause of thromboembolism is multifactorial and includes tumor type, alterations in coagulation, specific chemotherapy agents, and clinical considerations. Although these patients traditionally have been treated with standard unfractionated heparin (UFH) therapy, low molecular weight heparin (LMWH) has been studied extensively and is an acceptable alternative treatment. LMWH should be followed by a period of oral anticoagulants, although some patients may benefit from long-term heparin therapy. Oncology nurses are qualified to identify patients who are at risk for DVT and, in expanded roles, may manage patients on anticoagulant therapy successfully. CONCLUSIONS: LMWH followed by a course of oral anticoagulant therapy is an alternative way to treat DVT. Treatment with LMWH is less expensive than traditional UFH and has a preferred side effect profile. IMPLICATIONS FOR NURSING PRACTICE: All oncology nurses should be aware of the different risk factors for DVT in patients with cancer and current clinical management should DVT occur. Oncology nurses in expanded roles or advanced practice nurses may choose to manage DVT with LMWH followed by oral anticoagulant therapy. Some patients may require long-term treatment with heparin therapy rather than oral anticoagulants.
Subject(s)
Neoplasms/complications , Thromboembolism/drug therapy , Venous Thrombosis/drug therapy , Anticoagulants/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Neoplasms/nursing , Oncology Nursing/methods , Thromboembolism/diagnosis , Thromboembolism/etiology , Venous Thrombosis/diagnosis , Venous Thrombosis/etiology , Warfarin/therapeutic useABSTRACT
Over the past two decades, implanted ports have become widely used infusion therapy devices. Although these devices have revolutionized the care of patients with cancer and are used routinely to administer various treatments, complications still can occur. Nurses must be vigilant in identifying potential and actual port-related problems and aware that radiological studies may not immediately reveal a problem. Two unique case studies are described in which extravasation complications occurred despite negative initial catheter dye studies. A clinical algorithm is presented that outlines the management of a suspected port extravasation.
