Monoclonal Antibodies and Nursing

More than 500,000 deaths have occurred from COVID-19 in the United States

COVID-19 positive patients now have an option for treatment with monoclonal antibody therapy in some hospitals, but more likely in outpatient and long-term care settings. As a Registered Nurse tasked with administering monoclonal antibody therapy there are some things you need to know. Antibodies are proteins that the body can make naturally to fight off a virus and some antibodies are made in a lab. The FDA has approved three antibodies for emergency use to treat COVID-19. These antibodies include: bamlanivimab, casirivimab, and imdevima. Casirivimab and imdevimab must be given together and bamlanivimab is given alone.

First read your facilities policy on the administration of the monoclonal antibody therapy. Each facility has their own policy with a set of guidelines for administration of immunoglobulin therapy (IVIG) and monoclonal antibodies (mAbs).

So why are we using monoclonal antibodies and how do they help?

According to research the mAbs when given to patients early in their diagnosis of COVID-19 mAbs can be highly effective at avoiding serious illness, hospitalization, and in some cases death. The current mAbs that have emergency use approval by the Food and Drug Administration include bamlanivimab, casirivimab, and imdevimab. This treatment may save patient's lives and prevent unnecessary strain on the healthcare system. Additionally, there are stakeholders invested in the success of mAbs and data is still being collected and evidence is emerging from ongoing trials on the effectiveness of mAbs.

Let’s give the monoclonal antibodies

You have the order to administer the mAbs. What do you do next? You may be excited, nervous, and unsure. It is okay! Here are some burning questions you need to have clarity on before giving the medication

STOP

· Did you complete your facilities training program? To give you proficiency at delivering the mAbs ordered?

· Is informed consent obtained?

· Read the order again!

· Verify the five rights of medication administration.

o Right patient

o Right drug

o Right dose

o Right route

o Right time

The five medication rights will help prevent a medication error.

Now that you have verified these five rights let's give the medication.

STOP.

Are you giving the medication intravenous or subcutaneous? What is the rate of administration? Do you need to pre-medicate the patient?

Is your IV site patent? Is the IV site free of infiltration, pain, and redness? · How often do you need to do vital signs per your facility policy? · Is there a trained physician or mid-level practitioner on-site in case there is a severe reaction, and are they aware you are giving this medication now?

Is the facilities emergency code cart stocked with supplies during the antibody infusion?

No LPN’s are allowed to administer IV antibody therapy. · LPN’s may administer subcutaneous antibodies under supervision. http://www.op.nysed.gov/prof/nurse/nurse-iv-monoclonal.htm#

I hope this gives you some insight into information you need before you give monoclonal antibody therapy.