7 Infusion Therapy in the Home Care Setting The high cost of health care, reimbursement changes, chronic illnesses, and health care reform have made the home infusion setting a practical option for patients. In some cases, hospitalization for uncomplicated conditions can be avoided or patients may be discharged earlier than the estimated length of stay to receive infusion therapy in the comfort of their own home. In order to receive home infusion, the patient must participate in the care plan or have a willing and able caregiver. A home infusion company, as part of a hospital system or independent entity, may be involved in the plan of care. Home infusion companies work directly with licensed independent practitioners (LIPs) to provide the ordered medications, supplies, and equipment required to manage the patient at home. The nurse, the LIP, pharmacist, and if appropriate, a dietitian, work together to provide an effective and efficient treatment plan to provide positive patient outcomes. Specialized infusion services in the home 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. There is no specific standard for nurse-to-patient staffing ratios but consideration should be given for travel time to a patients’ home and nursing care required specific to the patient’s infusion therapy. The American Nurses Association’s Principles for Nurse Staffing suggest that the following factors be identified: volume of patients intensity level of the care needed by patients characteristics of the work environment, including architecture and available technology and experience and expertise of the nursing staff. Patient Care Considerations The criteria for patient selection and monitoring of patients who receive home infusion therapies have been established by various professional groups. Home infusion providers may provide care for patients across their lifespan. The patient is the central member of the home infusion team and must participate in his or her own care. If the patient is unable to participate in the care, then a willing and able caregiver must be present. The patient’s mental and physical abilities, self-confidence, anxiety, and fears should be assessed prior to admission to home 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.
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