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Monoclonal Antibody Project

 

Click here to access the LTCF Monoclonal Antibody Order Survey Link

(Please Note–The survey link above is only for Nursing Home and Assisted Living Residents)

Click here to access the Dialysis Center Monoclonal Antibody Order Survey Link

(Please Note–This survey link is only for HD center patients)

Resources

Background Information

Bamlanivimab Criteria

Lilly Bamlanivimab Antibody Playbook
(One-stop shop for bamlanivimab drug information, including administration instructions on Page 6)

Bamlanivimab Project Implementation Plan

Order Form and Fact Sheets

Bamlanivimab Prescriber Order Form
(Order form template that can be used to check for eligibility and document ordering the drug in your medical records)

Bamlanivimab Medical Director Standing Order Template
(Standing order template for bamlanivimab that can be used by facility Medical Directors)

Bamlanivimab EUA Patient-Caregiver Fact Sheet
(Patient fact sheet that must be printed and given to the patient or caregiver prior to or at the time of infusion)

Bamlanivimab Health Care Provider Fact Sheet
(Fact sheet aimed at providers that contains drug information and answers to other commonly asked questions)

During and After the Infusion

Bamlanivimab Emergency Meds
(List of required emergency meds. Note: These can be provided by the pharmacy at time of drug delivery if you do not have them on hand)

Epinephrine Administration for Anaphylaxis
(Helpful information for preparing and administering epinephrine in the case of anaphylaxis)

HCP-to-Patient Infusion Day Guide
(Informational handout targeted at patients that can help explain this drug and the infusion process. This is NOT required but may be a helpful additional resource.)

Bamlanivimab Data Collection Requirements and Survey Link
(Information regarding data tracking after patients have received bamlanivimab)

Reporting Process for Serious Adverse Events

Contact Information

For any questions regarding bamlanivimab or the request process, please contact Andrew Watkins at Anwatkins@nebraskamed.com

For facility staff members looking to request infusion training or educational resources, please contact Lisa Brand at Lisa.brand@unmc.edu

Page last reviewed: January 18, 2021