7 Infusion Therapy in the Ambulatory Infusion Setting The high cost of health care and decreasing reimbursement have made early discharge from an acute care facility to an ambulatory infusion setting for infusion administration a necessity. In some cases, hospitalization for uncomplicated conditions can be avoided by delivery of needed infusion therapy at an ambulatory practice site. An infusion center may be located in a variety of health care environments, including a provider’s office, a hospital clinic, an urgent care center, emergency department, or a free-standing infusion clinic. Infusion centers have health care professionals on-site and ready availability of medications, supplies, and equipment needed to respond to vascular access complications or emergencies. The nurse, physician, pharmacist, social worker, dietitian, and administrative staff work together to provide an effective and efficient communication system for designing treatment programs and promoting positive patient outcomes. Infusion centers allow for coordination of resources and efficient delivery of services. With staffing, equipment, and provider involvement similar to those in a hospital, the infusion center is a practical way to initiate extended outpatient care. Because of this similarity, some patients may perceive the transition from the hospital to the infusion center as less traumatic and perhaps better supervised than transitioning directly to home care and self- administration. Specialized infusion services in the infusion center include, but are not limited to, vascular access device (VAD) care antimicrobial, antifungal, and antiviral infusions continuous or intermittent chemotherapy administration various intramuscular and subcutaneous injections, infusions of intravenous immunoglobulin and other biologics, hydration solutions, and analgesics transfusion therapy and parenteral nutrition administration. Patient Care Considerations The criteria for patient selection and monitoring of patients who receive infusion therapies in the ambulatory setting has been established by various professional groups. The patient is the central member of the care team and must participate in his or her own care. The patient’s mental and physical abilities, self-confidence, anxiety, and fears should be assessed during discharge planning from the hospital. Limitations on ambulation, prolonged sitting, and access to transportation may weigh heavily against an ambulatory setting for treatment. Yet, home care may not be appropriate either for patients who live alone and are not able to adequately self-monitor their infusion care. An important role for the patient is reporting significant changes in vital signs and symptoms of adverse effects, including rash, nausea, vomiting, diarrhea, phlebitis, erythema, or purulence at the insertion site of the access device. Educating patients to be reliable team members involves encouraging them to communicate often with the nurse, physician, and pharmacist.