COVID-19 ACUTE INFECTION - MONOCLONAL ANTIBODY SQ INFUSION
Patient presents at MCHS for acute rehab services and currently is acute COVID-19 positive with a positive covid19 test completed on 11/3/2021. In efforts to determine if this patient requires treatment using the Monoclonal
Antibody Infusion as verified with the medical director and attending. This patient has previously received the
COVID 19 vaccine however does have an underlying depressed immune system. Associated s/s include reports
of mild cough, fatigue and muscle weakness however afebrile at this time.
This patient does not require supplemental O2 during active covid-19 infection. Patient is within 10 days of
symptomatic COVID-19 that is consistent with mild to moderate disease, AND has positive results of direct SARSCoV-2 viral testing AND is at high risk for progression to severe COVID-19, including hospitalization or death.
High risk conditions may include, age greater than or equal to 65, BMI >25, chronic kidney disease, diabetes,
immunosuppressive disease/treatment, cardiovascular disease, chronic lung disease, sickle cell,
neurodevelopmental disorders, tracheostomy, gastrostomy, or PPV.
Patient is hospitalized in a skilled nursing facility,. This patient is at high risk for progressing to severe disease
with potential for hospitalization; for this reason, the patient requires provider education and evaluation for
eligibility to receive the Monoclonal Antibody administration. Patient verbally agreed to have Antibody
Administration
Diagnosis/status/plan
Acute COVID 19 confirmed U07. 1; unstable
Z92.22 Acute Personal history of monoclonal drug therapy/R53.83 Chronic Other fatigue
Medical Record Reviewed:
The patient medical record and chart were reviewed. Eligibility to receive Monoclonal Antibody treatment was
reviewed per protocol. This patient DOES require Monoclonal Antibody administration.
Verbal consent for the administration of Monoclonal Antibody treatment has been obtained from the patient and
confirmed with attending MD.
Educated the patient regarding the risks versus benefits of the treatment including signs and symptoms of
administration related reactions of fever, chills, nausea, headache, bronchospasm, hypotension, angioedema,
throat irritation, rash, pruritus, myalgia, and/or dizziness. Additionally, I have explained the patient’s inability to
receive a COVID-19 vaccination during the following 90 days. Patient verbalizes understanding of education
provided. Will monitor this patient further. Findings and plan of care discussed with patient and nurse
Today this patient will be receiving REGEN-COV Subcutaneously. During the pre- subcutaneous assessment, the
patient is noted to be at baseline. Upon post infusion of monoclonal antibodies, the patient remains at baseline
with no adverse reaction noted. Complications at the time of infusion were not present. Will monitor with RN at
bedside (RN). Findings and plan of care discussed with patient and nurse.
VITAL SIGNS Q 15 MINUTES
1200:112/50, 65, 16, 97%, 97.3
1215:107/56, 68, 16, 97%, 98
1230: 133/58, 66, 16. 97% 97.1
1300: 124/53, 68. 16, 98% 98.9
Monoclonal Antibody administration provided by CRNP and RN charge nurse.
CCC: time spent on extensive chart review of hospital and medical records, physical exam and q15minute administration of
monoclonal antibodies REGEN-COV Subcutaneously x 1 hour, vital signs, patient assessment and education.
COVID-19 ACUTE INFECTION – EVALUATION FOR MONOCLONAL ANTIBODY INFUSION
Patient presents at MCHS for acute rehab services and currently is acute COVID-19 positive with a positive covid19 test completed on. In efforts to determine if this patient requires treatment using the Monoclonal Antibody
Infusion as verified with the medical director and attending. This patient has previously received the COVID 19
vaccine however does have an underlying depressed immune system. Associated s/s include reports of mild
cough, fatigue and muscle weakness however afebrile at this time.
Criteria for treatment with Monoclonal Antibody Infusion are any patient with mild to moderate
signs/symptoms of COVID-19 and are during the first 10 days of symptom onset AND with a positive
COVID-19 test result; OR patient has experienced prolonged exposure to a positive COVID-19 case.
Patient has had exposure to Covid-19 however unsure of exposure time.
Patient is not hospitalized at this time however resides in a skilled nursing facility, does NOT require new order
for oxygen however has PRN oxygen at 2L to keep sp02 > 93% if necessary.
This patient is at high risk for progressing to severe disease with potential for hospitalization; for this reason, the
patient requires provider education and evaluation for eligibility to receive the Monoclonal Antibody
administration.
Diagnosis/status/plan
Acute COVID 19 confirmed U07. 1; unstable
B34.2 Acute Coronavirus infection, unspecified
Z92.22 Acute Personal history of monoclonal drug therapy
POST INFUSION FOLLOW-UP
Patient is seen s/p Monoclonal Antibody REGEN-COV Subcutaneous Infusion which treatment was completed
yesterday. Consent for treatment was obtained verbally and this treatment that been approved by the FDA for
emergency use in the treatment of this patient’s mild to moderate COVID-19 disease as this patient is Covid-19
positive and is at high risk for progression to severe COVID-19, including hospitalization or death. High risk
conditions may include, age greater than or equal to 65, BMI >25, chronic kidney disease, diabetes,
immunosuppressive disease/treatment, cardiovascular disease, chronic lung disease, sickle cell,
neurodevelopmental disorders, tracheostomy, gastrostomy, or PPV.
During the pre subcutaneous administration assessment the patient was noted to be at baseline. Upon post
subcutaneous infusion of Monoclonal Antibodies, the patient remains at baseline without complication. Vital
signs post infusion remain within normal limits.
Monoclonal Antibody administration provided by Ryan Cohen, CRNP
The patient medical record and chart were reviewed. Eligibility to receive Monoclonal Antibody treatment was
reviewed per protocol. This patient does fit criteria for Monoclonal Antibody administration.
Verbal consent for the administration of Monoclonal Antibody treatment is obtained (depending on state) from
patient (and/or Healthcare Surrogate).
Educated the patient regarding the risks versus benefits of the treatment including signs and symptoms of
administration related reactions of fever, chills, nausea, headache, bronchospasm, hypotension, angioedema,
throat irritation, rash, pruritus, myalgia, and/or dizziness. Additionally, I have explained the patient’s inability to
receive a COVID-19 vaccination during the following 90 days. Patient verbalizes understanding of education
provided. Will monitor this patient further. Findings and plan of care discussed with patient and nurse
ONLY IF required:
Today this patient will be receiving REGEN-COV (select one: intravenously, subcutaneously), a treatment that been
approved by the FDA for emergency use in the treatment of this patient’s (mild to moderate COVID-19 disease OR- as post exposure prophylaxis).
Orders written to:
•
Obtain baseline vital signs.
•
Establish vascular access If applicable
•
Administer Monoclonal Antibody consistent with EUA to infuse using a sterile, in-line, low protein binding
0.2 or 0.22-micron filter
•
Post-infusion monitoring for hypersensitivity reaction for a period of 60 minutes and post-infusion vital
signs.
During the pre- (infusion -OR- subcutaneous administration) assessment the patient is noted to be at baseline.
Upon (post-infusion-OR- post administration) assessment, the patient (remains at baseline -OR- has developed s/s
of complications.) Complications at the time of (infusion -OR-subcutaneous administration) (were not present -ORincluded rash, fever, low BP with initiation of emergency interventions). Will monitor this patient closely. Findings
and plan of care discussed with patient and nurse.
Monoclonal Antibody administration provided by (select one: this licensed advanced practice nurse OR- infusion
team).
INCLUDE CCC Time:
__________exam, ______________ CCC time
HPI ELEMENTS:
ROS: (only need 10 ROS needed for Comprehensive)
Duration: COVID 19 test date
Severity: Mild/Mod/Severe s/s
Treatment: COVID 19 Vaccination,
Context/Onset: COVID exposure/ acute COVID 1
Associated s/s: cough, elevated temp, fatigue
GEN: fatigue
Eyes: denies problem
ENT: denies problem
CV: denies problem
RESP: denies problem
G.I.: denies problem
GU: denies problem
MS: generalized muscle weakness
Hem/lymph: denies problem
Neuro: denies problem
Skin: denies problem
Psych: denies problem
PFSH: (need 2 for Comprehensive)
1. Past medical history (comorbidities associated with risk for COVID 19) AND 2. marital status or living location
Physical exam: (only need 9 systems with 2 bullets each)
Constitutional: NAD, awake and alert
VS: 140/79, 99, 97.0, 20, 98%, WT: 190.2 LBS
Eyes: PERRLA, conjunctiva pink/anicteric
ENT: hearing non-impaired, lips and gums pink and moist, oral mucosa, tongue, palate are pink and moist
Neck: supple, no masses, symmetrical, trachea midline, no thyromegaly, no JVD
CV: RRR, no audible murmur/gallop/rub , trace edema to BLE, pulses palpable, digits W/O CCE
RESP: diminished bases with clear sounds, even, unlabored, no use of accessory muscles
ABD: bowel sounds present in all four quadrants, nondistended, nontender, no organomegaly
GU: no bladder distention or tenderness
MS: generalized muscle weakness, decreased ROM
Lymph: cervical without enlargement, supraclavicular without enlargement
Neuro: cranial nerves grossly intact, Superficial touch & pain sensation intact/vibratory sensation intact
Psych: alert and oriented three, pleasant and cooperative, recent and remote memory intact
Skin: warm and dry, No rashes, lesion, ulcers
Lab results: (include relevant labs)
COVID Test result
Most recent CBC & BMP
Most recent chest X-ray