IVIG home infusions - HELP! And a few other home health questions..

Specialties Home Health

Published

Hello! I recently took a job with a home health agency. I took a PRN position and am wondering if I should have done so. I have a few questions, so I will start with the one concerning IVIG. I was hired by an LPN, who runs the company. The problem is that LPN's cannot infuse IVIG, so she therefore cannot provide me any training regarding this. She has me set up with a patient who receives IVIG and called the patient to inform her that I would be coming TOMORROW without even asking me. The patient had the supplies taken to her house and is awaiting me in the morning. My problem: I have been a hospital RN for three years, but have only given IVIG once or twice. I have an order for the specific rates to infuse, and understand that I need to monitor vital signs, lung sounds, etc. However, I am unsure if I need to piggyback it into something (Like NS with blood?), or if I run it alone. Also, I know that PRBC's cannot be run over 4 hrs. Does IVIG have any time restrictions? The LPN told me to take about five hours, but when I calculate the rates given to me, it seems like it will only take 2 and 1/2 hours. I am very concerned about administering something I am not comfortable with, but feel obligated as she set this up without my knowledge. I called the patient to see if I could set it up for another time, and she started crying!! I am really unsure what to do, and appreciate any help!

Ok, so for my other questions. I am wondering if this job is like all home health agencies, or if I should start looking for another job. I am an RN, I took a PRN position because I am attending school full-time for my MSN. I was told I could choose my own hours and own patients being PRN. My manager called me today with two days worth of patients - one admit, and other supervisory visits and recertifications. I have never done any of these. She gave me the forms and told me they were pretty self-explanatory. I did not receive any training and am worried about completing things I never have done before. I do not have home health experience. The agency has about 80 or so patients and is currently picking up more, and only has one full-time RN and myself (there are also a few LPN's). I feel like I am going to be expected to see many more patients than I was told I would if there is only one other nurse (who is also brand new). I had to ask them to give me equipment - cuff, gloves, thermometer. I was told they didn't have pulse oximeters and other things because they aren't Medicare certified yet. I feel like they have just thrown me into this and I have no idea what I am doing!!! I'm sorry for writing a book here - I have no one to ask about this stuff!! I appreciate any advice, thanks for taking the time to read this!! :)

Up Vote Up Vote ×
Specializes in Home Health.

You should have MD orders that specify the amount of IVIG that is to be given, the volume and the rate. If you do not have this information you cannot administer the medication. There are not ifs, ands or buts about this. An LPN cannot run a home health agency, and cannot be DON. I think there is also some question about LPN's giving orders to an RN, but that would depend on the subject. In home health, an LPN cannot take orders from a physician. Orders must be taken by an RN. I have given IVIG in home and it is really no big deal, but I had all of the the information necessary to do so. You might need to look for another agency that has appropriate leadership. Bless you!

Up Vote Up Vote ×

Did you infuse and if so how did it go? I have to tell you that what your boss asked you to do was pretty negligent. IVIG is a complex infusion. It must be started slowly and increased in intervals dependent on the pt's vital signs, any side effects and overall tolerability. You would need to ensure any premeds were taken by the pt and an anaphylaxis kit is at hand. Is it a first dose or not? Do you know how to manage the side effects? Side effects are expected especially with first courses. There are expected infusion-related SE's that are manageable and those that are more severe adverse events that need to be reported. Knowing the difference is IMPERATIVE to the success of the infusion. Why is the IVIG being given? If for immune deficiency this is a life long therapy that needs to be managed so the pt can tolerate forever. If for an autoimmune disease, IVIG is often a third line treatment that is given when other meds have failed. It's a disservice to the pt if you infuse IVIG without understanding all of this up front and then the pt gets side effects and the infusions may be discontinued because manageable SE's are determined to be intolerability.

Home health jobs are wonderful! You do have more flexibility in your schedule and I love the one on one time with the pts and family. To me it is more rewarding to assist a pt to live in their home with various conditions and have quality of life. It sounds like you are working for a staffing agency rather than a certified home health agency. There is a lot more oversight with compliance and quality assurance with certified agencies, and although the paperwork can be time consuming at times, in general you would not be asked to do something you were not adequately trained to do because of that oversight, by state agencies as well as JCAHO. You may want to look for another agency that can compliment your school schedule but not ask you to put your license in jeopardy.

Up Vote Up Vote ×

Thanks for the replies! I did not infuse the IVIG. I called in the morning and told the manager I was not comfortable infusing without training. This company only has one other nurse - who, for some reason, is not to work with that patient. There is something odd about the situation, but the manager wouldn't explain much. The patient has an immune deficiency, and over 2 months ago the company's only RN at the time left - leaving no one to do the infusions. Instead of going to another home health agency, the patient said she would wait it out until another nurse was hired. They hired one, but they only worked together once. So, 2 months later, they hire me, and tell me to go give this treatment that the patient has not had for over 2 months! The manager (who, as I stated, is an LPN), wasn't sure if the patient's doctor knew she wasn't receiving her treatments. She told me to make some sort of note stating that the patient was now accepting her infusions. The whole thing had red flags all over it to me, and my instinct was to not do it. I am actually going to leave the job, as I have not had training on anything and they just expect me to understand home health nursing when I have no experience. I was really hopeful this job would work out, as it seemed flexible, but I don't want to do anything I don't feel safe doing. Hopefully I can find somewhere else that will work with my through school :)

Up Vote Up Vote ×

I have a question regarding IVIG in home health. Since this is a blood product, don't you legally have to have 2 RN's for bedside verification before administration? How is it legal to administer this in a home health setting without this considering the RN is often on their own? Any answers you can give would be most appreciated as I'm considering a home health job that administers IVIG.

Up Vote Up Vote ×
Specializes in Infusion Nursing, Home Health Infusion.

IVIG does not come from a blood bank and does not need two RN vetification since there is no risk of a mismatch as that is one major reasons for doing the check.

Up Vote Up Vote ×
Specializes in Infusion Nursing, Home Health Infusion.

I have given hundreds of doses of IVIG and all different brands.Each manufacturer lists the recommended infusion rates and start slowly and are ramped up to an eventual maximum infusion rate. Most patients take a premed of Acetaminophen and Diphenhydramine to manage adverse effects and to minimize hypersensitivity reactions.The most common side effect or adverse reaction is headache.Many patients experience flu=like symptoms such as myalgia,n/v,chills,fatigue and others.Most of these are easily controlled by reducing the rate of the infusion by 50 percent. If able by timing a repeat dose of the premeds can be given.Adverse reactions are not a reason to abandon the infusion and the patient can receive their IVIG if they have a fever.An ANA kit should be in the home and the nurse should know the policy for dealing with hypersensitivity reactions.The nurse administering IVIG should do some self study on the subjuct and there are many good articles out there. I personally would not have quit over just this. There are new IV drugs coming out constantly for chronic illnesses that I get asked to adminster and I just look them up and study the information and adminster them.

Up Vote Up Vote ×

It is not possible to learn how to practice as a home health nurse (RN job description) from a prn schedule. Nurses don't expect that for acute care positions, I don't know why it would be considered for a home health position where you must be able to function independently either coming with a solid skill set or a planned intense orientation as well as needing to learn the regulatory, reimbursement, and documentation requirements.

Up Vote Up Vote ×

I provide my IVIG nurses with inservicing per the IVIG manufacturer. If you go to the drug's website (Gammagard, Privigen, Octapharm, etc) there is often a link for training/education. This has been a big help to me. The pharmacy who provides the drug may also offer inservicing. I don't know who is in your area but Optioncare has an online training website that has a multitude of different topics.

Up Vote Up Vote ×
+ Add a Comment