When should a nurse practitioner reschedule a patient's appointment with the provider at an infusion site, considering the patient's medical history, including conditions such as cardiovascular disease, diabetes, or other comorbidities, and potential adverse reactions to treatment?

When Nurse Practitioners Should Reach Out to the Provider

A nurse practitioner at an infusion site must immediately contact the patient's provider when there are abrupt changes in disease-specific symptoms (such as GI symptoms in IBD patients), when patients exhibit symptoms requiring physician approval to proceed after rescheduling, or when adverse reactions occur during infusion that require treatment modification.

Mandatory Provider Communication Scenarios

Disease-Specific Symptom Changes

• Any abrupt change in the patient's underlying disease symptoms requires discussion with the patient's specialist 1
• For IBD patients specifically, changes in gastrointestinal symptoms must be discussed with the gastroenterologist before proceeding with infusion 1
• This applies regardless of whether the symptom change appears related to the infusion therapy itself 1

Persistent Infectious Symptoms Requiring Clearance

• When patients have persistent symptoms after initial rescheduling (symptoms lasting beyond 72 hours), the appointment should only proceed on the advice of a physician 1
• The protocol involves: cancel initial appointment, follow-up call in 72 hours, and if symptoms persist, delay at least an additional 14 days with mandatory physician approval before rescheduling 1
• This physician clearance requirement protects both the individual patient and the broader infusion center population from infectious disease transmission 1

Pre-Screening Triggers for Provider Consultation

• Patients should be screened 24-48 hours before their scheduled infusion 1
• Contact the provider when screening reveals: sore throat, cough, fever, shortness of breath, difficulty breathing, loss of smell/taste, or relevant infectious disease exposure history 1
• These symptoms warrant infusion cancellation and provider notification for guidance on rescheduling 1

Day-of-Infusion Red Flags

• Patients presenting with symptoms or fever at the infusion center require immediate isolation and provider consultation 1
• Temperature checks and symptom re-screening at center entry are mandatory 1
• The infusion must be rescheduled per provider recommendations rather than proceeding 1

Clinical Context and Rationale

Why Provider Communication Is Critical

The evidence emphasizes that patients on immune-modifying biologics are particularly susceptible to infections and complications 1. Delaying infusions even by a few days can affect treatment efficacy and immunogenicity, making the decision to proceed or reschedule a medical judgment that requires provider input 1. The nurse practitioner's role is to identify concerning changes and facilitate appropriate provider decision-making rather than independently determining whether to proceed with potentially risky infusions.

Common Pitfalls to Avoid

• Do not independently decide to proceed with infusion when disease-specific symptoms have changed - this requires specialist input 1
• Do not assume mild or "minor" infectious symptoms are safe to ignore - even minor symptoms warrant the full screening and provider consultation protocol 1
• Do not reschedule symptomatic patients without establishing a clear follow-up plan - the 72-hour follow-up call and physician clearance requirements are mandatory safety measures 1

Documentation and Communication Structure

• Maintain a telephone helpline and email system for provider communication during work hours 1
• Document all symptom changes, screening results, and provider communications in the patient record 1
• Establish clear protocols with the prescribing provider's office for urgent versus routine consultations 1

Special Considerations for High-Risk Patients

While the guidelines focus on infectious disease screening, patients with cardiovascular disease, diabetes, or other significant comorbidities warrant heightened vigilance 2, 3, 4. These patients may experience atypical presentations of complications and have increased risk for adverse outcomes from both infections and infusion reactions 5, 2. When such patients present with any concerning symptoms, the threshold for provider consultation should be lower.