Carson-Tahoe Hospital's Ambulatory Infusion Center grows after six years

The gray clapboard building tucked between the cottonwoods on Sophia Street doesn't look like a clinical setting, but it has been home to Carson-Tahoe Hospital's Ambulatory Infusion Center for about six years.

Originally created to relieve Carson-Tahoe Hospital's bed shortage, the center provides a place for patients needing chemotherapy or antibiotic infusions, but not hospitalization. To that end, it has become a proven asset for the hospital, at the same time offering some very real advantages for patients.

"We perform anything that can be done on an outpatient basis," said Deena McKenzie, director for the center. "Being able to receive services like these frees up beds in the hospital as well as keeping the price down for patients."

Also, patients being treated by specialists at University of California-Davis or Stanford can avoid the costly trips that would otherwise be necessary. Services must be coordinated through a local physician, but that extra step can be well worth the trouble.

"We are seeing more and more patients of this type all the time. It's a real advantage for pediatric patients," McKenzie said, noting that the children become familiar with the staff, making the ordeal less stressful.

Three registered nurses provide chemotherapy, blood infusion, and antibiotics administration as well as assisting physicians with bone marrows and lumbar punctures. The facility also employs three phlebotomist clerks, for outpatient lab work and drug screens.

But it is the critical infusions such as chemotherapy, antibiotics, and blood transfusions that take up the bulk of the nurses' time. All members of the nursing staff are chemotherapy-certified, and have special training in advanced cardiac life support.

Charge nurse Rosa Cortez noted that an emphasis on patient education is integral to the process. When patients know what to expect after therapy, it helps them to avoid complications once they return home. They know which symptoms to watch for, and when to call the physician or the staff at the AIC. It ultimately gives the patient the freedom to be in control of his/her own care.

"We (patient and nurse) work on this together," Cortez said. "It's not so scary, when they know what to expect, and what to do. We try to walk them through all of this, reinforcing every time."

"It's so important for the patients. (These nurses) become a key part of the family, and part of (the family's) coping mechanisms." McKenzie said. "The doctors may not have enough time, but the nurses can address all their (the patients') questions."

"The best thing about working here is the teamwork," Cortez said, noting that the group works closely together, and the patients sense that. "They (patients) come first, second, and third, and the petty stuff tends to get pushed into the background."

Problems arise when the facility is completely booked.

"The patient is stressed, because he knows that the diagnosis means death if not treated," Cortez said, noting that this kind of patient always want to get in right away. Depending on the circumstances, these patients are offered alternatives: they can either be hospitalized for treatment, or wait for an appointment, usually in a day or so.

The facility sees about 20 patients a month, many of them coming at regular intervals throughout that period. Infusions can take several hours, and knowing these patients so well ultimately leads to one of the most difficult aspects of the job.

"It's very rewarding when they go into remission, but very hard when you get attached to your patients and then you lose them," Cortez said. "I think that's the reason a lot of nurses don't get trained in chemotherapy. But they need us, so we make the best of it."


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