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Print IMS Health PRESCRIPTION AND MEDICAL NECESSITY REVIEW FORM FOR AMBULATORY INFUSION () PUMPS Reset THE COMMONWEALTH OF MASSACHUSETTS Executive Office of Health and Human Services Sections 1, 2,
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How to fill out for ambulatory infusion pumps

How to fill out for ambulatory infusion pumps:
01
Ensure that you have a thorough understanding of the specific instructions provided by the manufacturer of the ambulatory infusion pump. Familiarize yourself with the device's features, components, and any recommended procedures for filling it.
02
Prior to filling the pump, wash your hands thoroughly with soap and water to maintain a clean and sterile environment.
03
Gather all the necessary supplies, including the prescribed medication, sterile solution or diluent, syringes, and any additional components specified by the manufacturer.
04
Prepare the medication according to the instructions provided. This may involve diluting a concentrated solution, or mixing multiple medications as required.
05
Use a syringe to withdraw the prepared medication, ensuring accurate measurement and preventing any air bubbles from entering the syringe.
06
Attach the syringe to the designated port or connector on the ambulatory infusion pump. Follow the manufacturer's instructions for securely fastening the syringe and preventing any leaks.
07
Slowly push the plunger of the syringe to deliver the medication into the pump's reservoir. Take care to avoid any spills or contamination during this step.
08
Once the medication is successfully transferred to the pump, securely close the reservoir to prevent any leakage or tampering.
09
Follow the specific instructions provided by the manufacturer to properly prime the pump, ensuring proper flow of the medication through the infusion set or tubing connected to the patient.
10
Regularly monitor and maintain the pump throughout the infusion process, following the manufacturer's guidelines for any necessary adjustments or troubleshooting.
Who needs ambulatory infusion pumps:
01
Ambulatory infusion pumps are typically needed by patients who require long-term medication delivery, particularly those who require continuous or intermittent infusions.
02
These pumps are commonly used in home healthcare settings, allowing patients to receive medication without the need for hospitalization.
03
Patients suffering from chronic illnesses such as cancer, diabetes, or autoimmune disorders often benefit from ambulatory infusion pumps to ensure a consistent and controlled delivery of their prescribed medications.
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