8 .................. Policies and Procedures for Infusion Therapy: Home Infusion The VAD selected should be appropriate for the prescribed therapy. Peripheral catheters may be appropriate for short-term infusion therapies. The peripherally inserted central catheter is frequently the VAD of choice long-term catheters such as tunneled catheters or implanted ports present another option, especially when frequent blood draws are necessary in very active patients or in children. The patient should be included and educated in the decision process of VAD selection. According to the Infectious Diseases Society of America guidelines, consider- ations for outpatient antimicrobial infusion administration include the following: • Documented need for outpatient antimicrobial therapy • Patient’s health care resource needs are available at the proposed outpatient site • Safety of the home for supporting needed care is addressed • Patient and/or caregiver willing to participate in care • Mechanisms are in place for rapid and reliable communications for patient monitoring • Patient and/or caregiver understand the risks, benefits, and economic considerations Home Infusion Nurse As a method of public protection to ensure safety, the infusion nurse should be clinically competent in the safe delivery of infusion therapy and VAD insertion and/or management within his or her scope of practice in the home care setting. Pharmacological and technical advances demand that the nurse working in a home care setting be specialized and knowledgeable in order to offset the risk involved and maximize value for the patient and the health care organization. The infusion nurse must demonstrate accountability, reliability, initiative, and effective communication and technical skills. Clinical competencies describe practice and educational requirements and provide validation for professional infusion nursing practice. Clinical competencies include many tasks that infusion nurses perform on a daily basis, from initiating, monitoring, and terminating infusion therapy, to educating the patient or caregiver, to collecting and analyzing data. The home infusion organization must define the competencies that are the responsibility of the infusion nurse and the organization in their policy and procedure. Competency assessment and validation should be performed and documented initially and on an ongoing basis. Achieving and maintaining board certification, noted by the CRNI® designation, is one method for documenting continuing competence and should be encouraged and supported.