ACTH for Infantile Spasm [PROTOCOL]
Child Neurology, Pediatrics, RN (VNA), Patient Management
ADMISSION:
· ACTH ordered prior to admission based on weight/height using Acthar IS Calc app and mail delivered to family.
· Admit patient to Neurology service once ACTH delivered.
· Pediatrics Resident completes medication reconciliation, places initial admission orders, and H&P
· Pre-ACTH labs and appropriate diagnostics
a. CBC, CMP, Mg, PO4, CRP, UA+UCx, RVP (CXR if indicated)
b. ID consult to r/o acute infectious process ( if indicated)
· Endo consult (if possible)
· If cleared, begin ACTH therapy (per Neuro calculated dosing)
· Blood glucose (BG) qD and q4h vitals per floor protocol
· Family demonstrates ability to perform ACTH injections
PRIOR TO DISCHARGE:
· ACTH taper per Neuro dosing provided to family (must express understanding)
· Udips provided to patient from High St
· BG strips and glucometer provided by PHS/Neuro/Endocrine/Endo educator
a. Family demonstrates ability to obtain Udip and BG independently; Can be taught by Endo educator/floor RN; VNA to help in home setting
· VNA setup via PHS – BG testing assistance, BP checks (manual)
· Appointments setup by PHS:
a. F/U with Neurology ideally 10 days post-discharge with EEG prior to taper completion (323-6150 to schedule)
b. F/U with Endocrine in 1-2 weeks post-ACTH taper complete