FACILITY OPERATIONS
Effective anemia management begins with the healthcare team
The healthcare team functions in an interdependent manner and should strive to work seamlessly
Responsibilities associated with these roles may differ from facility to facility
For all HCPs
- Analyze Hb trends
- Check Hb
- Trend data
- Administer EPOGEN® dose
- Report lab results
- Maintain patient charts
- Provide patient education and instruction
- Coordinate visits to anemia management center
- Design appropriate, iron-rich diet
- Coordinate reimbursement to ensure access to care
- Ensure each team member has appropriate resources to optimally perform roles
- Identify and report conditions affecting anemia management (eg, infection, inflammation, low dialyzer reuse, etc)
- Administer treatment medications
- Monitor quality anemia management outcomes
For physicians only
- Order labs
- Determine initiation of EPOGEN® dose
- Write anemia protocol
A team approach is necessary to optimize anemia management in your facility
- Identify the most common facility issues influencing anemia management in your unit
- Develop a team-driven action plan to address facility issues and optimize anemia management
Certain patients are at increased risk for low Hb levels5,24,25*
* According to the End Stage Renal Disease Clinical Performance Measures Project and recent studies, which assessed patients with Hb < 11 g/dL. The EPOGEN® PI recommends a Hb range of 10 g/dL to 12 g/dL.
In an action plan, patients with an increased risk of low Hb should be assessed
- Physicians should use their discretion in determining which patients are appropriate for ESA therapy
- Important considerations for treatment include:
- Examining all underlying causes of the patient’s anemia
- Establishing that the patient is iron replete
Communication and teamwork are key to achieving and maintaining continuous quality improvements
To optimize patient care, the healthcare team should establish:
- Multidisciplinary care conferences that are attended by the physician, nurse, nurse manager, social worker, and dietitian
- Discuss most common facility issues
- Communicate any protocol changes
- Discuss unique protocols related to specific patient situations (ie, post-hospitalization, incident dialysis, missed dose, and infection/inflammation)
- A formal process for monitoring and tracking HbA1C levels of diabetic patients
- An ongoing training program for staff
- An inter-shift communication log book
- The assembly of nursing teams so that less experienced nurses are paired with senior nurses
These practices were ranked among the 30 best in dialysis care in a 2005 US survey of 342 healthcare professionals26
Indication
EPOGEN® (Epoetin alfa) is indicated for the treatment of anemia in patients with chronic renal failure (CRF) on dialysis. EPOGEN® is indicated to elevate or maintain the red blood cell (RBC) level and to decrease the need for transfusions in these patients.
WARNINGS: INCREASED MORTALITY, SERIOUS CARDIOVASCULAR EVENTS, THROMBOEMBOLIC EVENTS, STROKE
and INCREASED RISK OF TUMOR PROGRESSION OR RECURRENCE
Chronic Renal Failure:
- In clinical studies, patients experienced greater risks for death, serious cardiovascular events, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target hemoglobin levels of 13 g/dL and above.
- Individualize dosing to achieve and maintain hemoglobin levels within the range of 10 to 12 g/dL.
Cancer:
- ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies in patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers.
- To decrease these risks, as well as the risk of serious cardio- and thrombovascular events, use the lowest dose needed to avoid red blood cell transfusion.
- Because of these risks, prescribers and hospitals must enroll in and comply with the ESA APPRISE Oncology Program to prescribe and/or dispense EPOGEN®
(Epoetin alfa) to patients with cancer. To enroll in the ESA APPRISE Oncology Program, visit www.esa-apprise.com
or call 1-866-284-8089 for further assistance.
- Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy.
- ESAs are not indicated for patients receiving myelosuppressive therapy when the anticipated outcome is cure.
- Discontinue following the completion of a chemotherapy course.
Perisurgery: EPOGEN ® increased the rate of deep venous thromboses in patients not receiving prophylactic anticoagulation. Consider deep venous thrombosis prophylaxis.
- EPOGEN® is contraindicated in patients with uncontrolled hypertension.
- Patients with chronic renal failure (CRF) participating in clinical studies experienced greater risks for death, serious cardiovascular events, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target hemoglobin levels of 13 g/dL and above.
- Patients with CRF and an insufficient hemoglobin response to ESA therapy may be at even greater risk for cardiovascular events and mortality than other patients.
- These events included myocardial infarction, stroke, congestive heart failure, and hemodialysis vascular access thrombosis.
- A rate of hemoglobin rise of > 1 g/dL over 2 weeks may contribute to these risks.
- Cases of pure red cell aplasia (PRCA) and of severe anemia, with or without other cytopenias, associated with neutralizing antibodies to erythropoietin have been reported in patients treated with EPOGEN®.
- This has been reported predominantly in patients with CRF receiving ESAs by subcutaneous administration.
- PRCA has also been reported in patients receiving ESAs while undergoing treatment for hepatitis C with interferon and ribavirin.
- A sudden loss of response to EPOGEN®, accompanied by severe anemia and low reticulocyte count, should be evaluated.
- If anti-erythropoietin antibody-associated anemia is suspected, withhold EPOGEN® and other ESAs. EPOGEN® should be permanently discontinued in patients with antibody-mediated anemia. Patients should not be switched to other ESAs as antibodies may cross-react.
- Seizures have occurred in patients with CRF participating in EPOGEN® clinical trials.
- The most commonly reported side effects in clinical trials were hypertension, headache, arthralgias, and nausea.
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Develop an action plan to improve patient and facility outcomes
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