home iv therapy

  1. I work in home care on the IV team. We recently recieved a patient on service who is a known IV drug user. Everyone (nurses and pharmacist) on the IV team felt this patient is inappropriate for home care service. Management felt differently and accepted the patient, against a strong plea against it. Does anyone have thoughts, suggestions or even legal/ethical advice.
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  2. 13 Comments

  3. by   TazziRN
    Yikes! Part of me wants to say that even IVDA's need home care too, but that's like waving in his suppliers from the front door!
  4. by   jnette
    Wow.. that's a tuff call. Shew !
  5. by   Agnus
    Please, forgive me my ignorance. I am trying to understand here. How is this patient inappropriate? Certainly you do not think that having an IV access in place is going to change anything. This person will do venipuncture his self to inject his drug of choice and generally this type of patient is better at obtaining IV access than we are.

    He does not need an access device. What is the fear that you and your collegues have? Is the therapeutic medication a narcotic? If so does he have access to the medication? I'm guessing no.

    If you had this patient admitted or come into an out patient setting to get his infusion do you think that you could better control his access to drugs? You cannot control his access to his own veins which he has become very adept at accessing.

    A determined user will obtain what he needs no matter what. If he is going to use, he will. I don't believe you are making it any easier for him by doing home infusion. Please, help me understand your concern.
    Last edit by Agnus on Apr 6, '03
  6. by   renerian
    WE took patients like that all the time. They still need help irregaurdless.

    renerian
  7. by   fitzman
    I appreciate all the responses. I am not sure people understand my question. I am aware people who use drugs need health care, are pros at accessing their own veins and agencies take them on service irregardless. My thought is what risk is the nurse at and what is the nurse's liability. If this patient decides to mainline his recreational drugs via the IV, which I knowingly allowed him to have, and he overdoses, can I be held liable for not acting on his history and removing the IV. Sure he will still abuse drugs, but should we be sending him home with easy access to his viens. The same situation is with physicians. Doctors will limit narcotics (if not prescribe them at all) to those who have chronice pain or have drug abuse history no matter what the patient's pain level. Why, because of liability. I wonder the same scenerio with IV access on these type of patients in the home care setting. There is also the risk to the nurse going into a home not knowing is the patient going to be straight or wacked out. Yes I already have my opinion, which is the patient should go SNF (where he can be monitored closer) until he has completed his IV therapy. If he chooses not to go SNF then he does not get IV therapy. I hope this expresses my concern clearer. Thank you for your responses/ADVICE.
  8. by   WalMart_ADN
    at first your question had me confused...but now i see your point. damned if you do, damned if you don't. good luck with your dilemna.
  9. by   KP RN
    Doesn't your agency have a written policy about this??
    I suppose the most important thing is to DOCUMENT!! I would write up a contract clearly delineating why you are concerned, and specifically what the IV access is to be used for, and what it is not to be used for. Have the patient sign the contract, one copy stays in the home, another copy goes in the chart.
    Also document that you have discussed this with the MD and get his/her input as well.
    At our agency, if we have reason to believe the patient violated our agreement/contract-they are history. They can go find another agency.
  10. by   renerian
    Good idea KP. We also had clients we pulled the line out after each med and ran the meds in via gravity. I would also probably talk to the DR., the client, sig others, and your super and document everything, plus your client ed on IV drug use not being part of the plan.

    renerian


    renerian
  11. by   purplemania
    What about people who overdose on oral meds? Should we tape up their mouth???
  12. by   JNJ
    Has your agency overlooked that psyche RN visits are appropriate here to support the patient (and, indirectly, the staff) with a difficult situation?
  13. by   Agnus
    The patient if competent bears responsibility for his own actions. If you did your patient teaching and documented it and the patient is competent then I don't think you are responsible for what he chooses to do. He can just as easily mainline and overdose without the device that you put in.

    Who is going to hold you liable? I personally doubt any court criminal or civil would hold you responsible for that kind of action. Unless you had clear indication, such as a statement by the patient, that he intends to harm himself.

    Again he can mainline without your device.

    If the patient is "wacked out" surly your agency has a policy
    on how to handly such a situation. Again, there is no guarentee that he won't be "wacked out" if you remove the device after each infusion. Because he does not need it. Because if he is going to use he will.

    When I did home care I had a situation with a client who was an adict where I thought I was being used inorder to make a buy. My agency invistigated. I was taken off the case for my own protection and COMFORT. If you are not comfortable in this situation (I can understand that), then perhaps you should decline this case. Sometime we are not the right nurse for the client. IN my situation I learned that the client had been picked up again by my agency. I do not know the outcome of the investigation but I can see where my perceptions may have been incorrect, at the same time I and this client were not a good mix.
    We cannot control and do not have the right to control what another adult choose to do with their own body/health. I am a nurse not a law enforcement officer. I have an obligation to protect my client and I have an obligation to protect myself. I have a right to feel safe in my work enviroment. I have an obligation to avoid a situation where I could be at risk of being involved in a crime. I have the obligation to report actual or suspected crimes. But I am not a police officer so I cannot physically stop an adict.

    All of this is just my opinion. I think if I were sufficiently uncomfortable with a certain client I would refer the client back to my agency and remove my self from the case. If my agency did not permit that then I would have to leave the agency. Again that is just me. I know agencies themselves refuse and fire clients from time to time r/t client behaviors.
  14. by   Agnus
    Perhaps the legal issues that you raise might best be answered by an attorney. Have you asked your risk manager, or the insurer that covers you or the one that covers your agency?

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