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.