A nurse recently administered filgrastim intravenously to a client who has cancer and is receiving cytotoxic chemotherapy.
For which of the following data, discovered after the medication was administered, should the nurse file an incident report?
A.
The client had chemotherapy 12 hr before the medication was administered.
B.
The medication vial sat at room temperature for 2 hr before it was administered.
C.
The client’s absolute neutrophil count was 2,500/mm³ before the medication was administered.
D.
The nurse flushed the client’s IV line with dextrose 5% in water before and after the medication was administered.
The Correct Answer and Explanation is:
The correct answer is B. The medication vial sat at room temperature for 2 hours before it was administered.
Explanation:
Filgrastim (Granulocyte Colony-Stimulating Factor) is a medication used to stimulate the production of white blood cells, particularly neutrophils, in patients undergoing chemotherapy. It is critical for the nurse to adhere to proper storage and handling guidelines to ensure the medication’s efficacy and safety.
Storage and Handling of Filgrastim: Filgrastim is typically stored in the refrigerator (2-8°C or 36-46°F) and should not be exposed to room temperature for extended periods. According to manufacturer guidelines, filgrastim should be kept at room temperature only for a limited time (usually no more than 24 hours) and should not exceed this time to avoid potential degradation of the medication.
Why Option B is Critical: In option B, the medication vial was at room temperature for 2 hours before administration. While 2 hours may seem like a short duration, it is crucial to note that any deviation from recommended storage conditions could affect the potency and safety of the medication. The risk is that the medication could become less effective or potentially unsafe if it has been stored outside the recommended conditions for too long. This deviation warrants an incident report as it could impact the client’s treatment outcomes and safety.
Why Other Options Are Less Concerning:
- Option A: The timing of chemotherapy relative to the administration of filgrastim (12 hours prior) is within acceptable practice. Filgrastim is often administered after chemotherapy to aid in recovery of neutrophil levels.
- Option C: An absolute neutrophil count (ANC) of 2,500/mm³ before administration is within the normal range. Filgrastim is typically used to boost neutrophil counts when they are low, so this ANC level does not indicate a problem.
- Option D: Flushing the IV line with dextrose 5% in water (D5W) before and after administration is a common practice to ensure the medication is fully delivered and to maintain line patency. This action is appropriate and does not require an incident report.
In summary, the most critical issue is the improper storage of filgrastim, which is why option B necessitates an incident report to document and address the potential risks involved.