IV Dobutamine + homecare

[NRSKarenRN, BSN, RN]

IV dobutamine was developed since I left IV homecare infusion in 2000...

Homecare referral today for Medicare private fee for service (PFFS) patient with IV dobutaine via to be managed by seperate infusion company....

Called to ask visit frequency of IV RN and told they would visit Mon/Wed /Fri for IV infusion---- thought this had to be a continuous drip???? OR am I misundersanding that they will assess pt MWF and change infusion pump cassette and CP assess patient???

Two agencys can not bill for same discipline under MC regs so think that applies to MEdicare PFFS also...

HELP!!!!!!!!

[joeyzstj, LPN]

Im not sure, however I would assume they mean they assess on those days. Dobutamine has a very short half life. Due to this it is a continuous drip. It amazes me with some of the things they do homecare on these days. Half the time the floors wont even take dobutamine drips. I guess if that is your only option and you are informed of the risks of the medication then more power to you.

[UM Review RN, ASN, RN]

As you know, I don't do home care and this sounds like a case management or billing problem. I still have some questions:

Why is the patient getting dobutamine at home?

I also wonder if the IV nurse can clarify which specific tasks she'll be doing related to the infusion. If it's a continuous drip, I'm assuming that it'll be administered through a PICC line at a low rate.

[Corey Narry, MSN, RN, NP]

We've discharged our advanced heart failure patients on Milrinone drip at home. They go home with a PICC line and the infusion company provides a smaller infusion pump device that the patient carries like a purse with a shoulder strap and I believe a different concentration of the drug solution that allows for a longer period between bag changes is used. The infusion rate is parked at a specific dose and not titrated. Maybe Dobutamine was used in this instance because the patient did not tolerate Milrinone?

[Dinith88]

Why is the patient getting dobutamine at home?

.

People in late stage chronic-CHF sometimes visit infusion clinics (once a week or so?) for symptom control, etc. (ie they profuse their kidneys, diurese, etc) and can minimize re-admissions for these patients...which can cut hospital/provider/insurance/medicare costs, etc. I'm not sure how common a practice it is nationwide...and is done less (i think) in my area than it had been done in the past...and certainly these patients are 'dobutamine experienced' ...as initiating this drip for the first time would require a bit more intensive monitoring.

I think taking the dobutamine to the home would be an even greater way to say some money for these providers/insurers/etc. ...and a logical step.

[iluvivt, BSN, RN]

Yes I do this in home care. I usually see more of the Milrinone. I even teach patients and their caregivers to change the bag. Once the patient is able to provide self-care we often just go out once a week to change picc dressing and caps or port needle and caps and assess. Will also perform prn visits as well.but a 3x per wk schedule is good..more than we get.