At Home Nursing...

P_RN, ADN, RN · Jan 7, 2002

Hi GD and welcome to the board!! Love your choice of college mascots!!!

Congrats on the wedding.

We started sending people home on IV abx from the hsp about 12-13 years ago. The infusion agency would come into the hospital and teach the patient and a family member and if they "passed" they met them at home for the first dose.

Since they used different equipment from jelcos all the way to tubing and pumps they had to do the first setup. I believe that a *nurse* could even do it (said facetiously.) Many times the med was set up using an ambulatory pump worn in a fanny pack.

My hubby's doctor frequently tells me to just call him with problems/ results/ blood sugars/ etc. and we handle a lot by phone. After all they trust us in the hospital don't they?

I saw your page!! Good for you!!! Our cousin lives in S'pbg and is chaplain at Woff.

P

RNCM · Jan 7, 2002

Dear Wrightgd

Home IV therapy is done frequently by appropriately taught lay people. I have done it previously for my husband. I think it really will depend on the comfort level of your husband's physician. If it is an antibiotic, perhaps the first dose can be given at your local ER to check for adverse effects, but then you should be able to handle that easily at home. I would have a frank discussion with the physician and find out what his hesitance is. Perhaps he is not familiar with all the things that can be done in the home setting. I would imagine he should be tickled pink to know that you are caring for him at home - CONTINUOUS HHC!!! How wonderful!

Karen4HIM1951 · Jan 8, 2002

:) :) :) :)

GUESS WHAT?

There are many home health agencies that can come out to the home and administer IV's (from antibiodics, to Hydration and even Chemotherapy thru a variety of methods (pumps to gravity).

These Nurses will either come to the home for each dose, to change bags or to teach family how to do it. All a Md has to do is to call a home health agency and order the service.

Many agencies will administer first doses in the home - but a few will not! We administer thru Peripheral IV's, PICC lines, Central lines, implanted ports and even epidurals.

How do I know? I'm a Home Health Nurse in NC that does just that! We are even going to be trained in placing PICC lines in the home!

With you being a Nurse already, a home health agency probably only would need to come out once originally to make sure you are familiar (or become so) with their equipment and setups and then be on standby if any help is needed!

H O P E T H I S A N S W E R E D Y O U R Q U E S T I O N ! !

sajaha · Jan 8, 2002

Hi there! Well, I've given it many times at home and I've had it given to me at home. So, yes, it is widely accepted practice in the home setting. You being a nurse I don't know why a doc would hesitate.

I gave myself IV Solumedrol many times at home. Someone starts the IV then I give it to myself. Now, if it is a new med for the patient, I would want one dose given in a setting where you could get help if need be but after that, go for it!

sara

Home Health Columnist / Guide · Jan 8, 2002

Welcome Wrightgd! You've come to the right place for answers. Hope you visit frequently and post often.

As Homecare + IV Therapy RN (including blood administration) for the past 15 + yrs along with coordinating home infusion therapy intakes for two years, I'll answer your concerns.

A. How many of you have had personal/family health issues where it was more convenient to administer nursing care at home to your own family members, instead of making a return visit to your doctor? I mean why drive all the way to the Dr.'s office, wait for an hour to be seen by a nurse (which you are), and perhaps have to return again for several more visits?

Homecare is the best place for the chronically ill or those with extended illnesses to receive nursing and healthcare services. There needs to be one person to act as coordinator, if the patient/client is unable to do so. Most nursing care provided in the hospital's/SNF can be provided in the home setting. Home care nurses act under Plan of Treatment orders they receive from a persons primary doctor/practitioner(PCP) or a specialist. (Most RN's / Physical Therapist write out the orders based on intake information/hospital discharge orders + forms/faxed info and discuss with the referring doctor and send the orders to them for signature).

Homecare nurses are well respected as being the doctors eyes and ears in the patients home. HOWEVER, follow-up visits with the doctor are also important to validate nurses assessment and fine tune medication management.

I've cared for several family members at home. Sometimes you are so close to your loved one, that you overlook subtle clues you would have picked up in your own patients. I've had some nurses be in denial over the declining health status or minimize serious problems that needed prompt attention in family they were caring for too. PCP's can be objective during visits.

B. Since I am not involved in Home Health, I am curious as to whether IV medication administration is allowed in the home, and what precautions are required for those cases?

C. All a MD has to do is to call a home health agency and order the service.

I wish it were that simple!

IV Home Therapy has been in existence since the early 1980s.

Questions to ask re the appropriateness for home therapy are:

1. Does the client have active insurance? Does the medical diagnosis support the rationale for IV medication? Will the insurance company cover the cost of IV therapy?

Medicare will cover VERY limited IV therapy: some Chemo, TPN with appropriate GI DX, pain mgmt when intractable unrelieved by PO; almost NO antibiotics (used to be just Vancomycin and Amphoteracin B). However, they will pay for SN visit to administer if client unable. If the client has secondary insurance, often they will pay for drug and equipment cost as way of reducing costs.

2. Is there a caregiver available and willing to assist or is client able to self administer once IV access obtained?

3. Is the home setting appropriate: Running water, electricity and refrigeration available? Any sanitation hazards?

4. Risk of adverse reaction to IV medication. All agency's have first dose guidelines.

Client's need to have received IVAB in the past, first dose in hospital or arrange for first dose in PCP's office. OK IV meds for first home dose are e.g. insulin, IV Solu Medrol, IV Decadron, IV Hydration solutions with potassium. Used to be standard practice to send anaphylactic kit to each client with high risk anaphylaxis but got so expensive most companies cut back to just IV RN carrying one kit and having standard orders.

5. Type of IV access needed for home therapy and does patient have any veins left for peripheral therapy? Will insurance pay for PICC /midline (best for more than 10 days of IV therapy needed). My PICC certification dates back to 1995, one colleague was doing them at home in 1994! Or is Portacath/Hickman needed (Medicare won't pay for IV supplies nor flushes needed for followup care).

6. Need for lab work to monitor therapy, will Insurance Co. pay for RN labwork draws? Is patient capitated to a specific lab for blood to be processed? Is home draw by phlebotomy lab tech available if RN not covered, or does client need to go to PCP's office?......HINT: can RN do bloodwork as part of routine visit to assess IV site/ medication compliance and just drop blood off at PCP's office?

7. Is infusion RN available 24/7 for home visit if complications develop??

I have taught many children and 80 year olds to do IV therapy along with " Nervous Nellie" spouses. Sometimes I've prepared two days IVAB by prespiking IV bags, leaving in refrig and all patient had to do was connect IV, turn on/off clamp, and SASH flush. Had one client who was big time TV broadcaster...his wife administered three IVAB prior to on air time and he wore Morphine PCA pump. No one knew until cancer was way advanced.

E-mail if specific response needed.

wrightgd · Jan 8, 2002

Thanks to all of you who have offered insight into this arena. My wife is still battling with a UTI/nephritis, that won't resolve itself on oral or IM antibiotics, and the urologist can't seem to find any root cause for all of the complications she is having... And it seems to be more than just an infectious process...

Thanks again,

George

Home Health Columnist / Guide · Jan 8, 2002

Possibly needs second urologist opinion. What additional tests have they done?

wrightgd · Jan 9, 2002

So far she has had several voided and one cath UA with culture... The cultures have shown nothing significant.

X-ray, renal ultrasound, CT, and tomorrow we go for a nuclear scan... She has had some vascular disease issues in the past... long term Coumadin therapy (6mg qd) for 20+ years, Greenfield filter, etc.... Current suspicion is decreased renal perfusion... Renal ischemia might explain the intense pain she has experienced, but I'm not sure about the cause of the recurrent infections... Urine output remains good, but she has retained some fluid over the last several weeks... Lab values all seem normal... BUN, creatinine, CBC, electrolytes... etc.

So far all they can come up with is that she has three small, non-obstructing stones in the right kidney... However, her pain is on the left side and the low midline abdominal area...

She's tough, but this is starting to get her down. It's frustrating and we both just want her to feel better... We have too many miles to hike on the AT this summer...

Home Health Columnist / Guide · Jan 9, 2002

she has three small, non-obstructing stones in the right kidney... However, her pain is on the left side and the low midline abdominal area

Husband with 90 kidney stones....his mother also had them too.

Some times have seen that stones are partially obstructing with scar tissue formed at back of ureter; if kidney not properly filtering, may cause backflow into other kidney.

Mother-in-law thought her abd pain due to stone..vage bloating too, minor UTI...no cause on xrays x 6 moths----found to have Ovarian CA. I would suggest a trip to GYN next if other tests inconclusive.

PS---told she had 3 months to live when diagnosed; Nancy died 10 years later from s.e. of chemo!