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In November 2020, during the COVID epidemic, monoclonal antibody infusions such as bamlanivimab were identified as an effective treatment for more severe cases of SARS-CoV-2 and were given emergency use authorization (EUA) from the U.S. Food and Drug Administration (FDA, 2020). At our large academic medical system, ambulatory care nursing leadership was tasked with collaborating with pharmacy services, infection prevention, supply chain management, information resources (IR), facilities, and the Epic training team to open an infusion area that could provide biologic infusion services for actively symptomatic COVID patients meeting the medical criteria for treatment. Thus, the COVID infusion clinic was opened within a space originally created for COVID-19 testing with the help of our COVID readiness team, which included staff from ambulatory care nursing operations and other interprofessional teams listed above.
The goal of the initiative was to provide biologic infusion therapy to patients that were high risk for progressing to severe COVID-19. We aimed to do so in a safe environment that reduced the risks of endangering staff or other healthy patients on campus and to decrease the risk of positive COVID-19 patient admissions via the emergency room. One challenge to accomplish these goals was the need to identify clinical area isolated from common patient and staff access, while also meeting the logistical and engineering specifications of needing a negative pressure space within the existing building. This space was identified and created to accommodate the much-needed monoclonal antibody infusions.
Additional challenges included identifying available support staff for patient scheduling and check-in, as well as to identify available infusion certified and trained RNs to administer the infusions to patients. Coordination of additional tasks included identification of necessary supplies, determining the clinical workflow, creating a scheduling template, and creating a staff schedule template based on 7-day-a-week, 8-hour-a-day operations. Collaboration continued, as education and training needs were identified, including PAPR training for all clinical staff. Additionally, pharmacy and logistics leadership were tasked with ensuring the workflow for drug mixing and delivery coincided with the infusion clinic workflows.
As a result of this initiative, over the last 12 months over 750 SARS-CoV-2 positive patients have received and continue to receive treatment with monoclonal antibody infusions. Due to our focus on infection prevention and safety for patients and staff, we have been able to provide this crucial treatment to a vulnerable patient population without an infection transmission to any of the infusion staff.