need legal info: NEW to IV infusion Home Health

[CeciliaFae]

I've found many topics helpful on here, but I'm looking for comprehensive info. I'm an RN with 4+ years experience ranging from CCU, PCU to med-Surg, tele, stroke. I had clinicals in home health as a student, but no work experience there. I am beginning a career as a HH IV infusion RN VERY soon.

I know as a BSN, RN I had training in school to start IV's, thus assuming this is included in my license. I also had training at my first hospital to change PICC dressings as needed.

I know at my second job the IV team started IV's, did PICC dressings as well as inserted PICCS and handled central line dressing changes.

My question is what training on my new HH IV infusion should I expect? Am I legally cleared to change central lines and PICC dressings based on having a BSN, or must they train me/have documentation of training? Is training in the office efficient or is there a specific certification from an outside source that must be obtained before performing this duty (like a seminar/ practicum from ANA) ?

And, on an offhand note, my malpractice insurance was made under that I am a med-surg RN, should I change the category to HH or IV infusion? Would it matter?

[Anna Flaxis, BSN, RN]

If you are an RN, then infusion therapy is within your scope. Whether you are a BSN is irrelevant. It is the RN license that defines your scope, not your degree.

Even so, having an RN license does not automatically make you competent in PIV insertion and CVC/PICC dressing changes. These are skills that you need to be taught how to do and provide return demonstration of competency before you are allowed to practice them independently. I would imagine your employer will provide you with this training during your orientation period.

[Asystole RN]

This is a question that would highly depend upon your local SOP and the BON advisory opinions. For simple dressing changes and basic PIV insertion/maintenance you most likely do not need any extra documentation.

If you were inserting PICC lines then this would be a different situation.

I would change the malpractice insurance to reflect your current setting.

[iluvivt, BSN, RN]

I have worked for 3 Home Infusion companies and my current company I have been there for 13 years. The type of training you will receive depends upon the agency. Typically they send you you out with one of the experienced nurses and try to get you a variety of visit types. Try if you can to get open visits for TPN, antibiotics, IVIG,Remicade, chemotherapy, Milrinone and any other types of visits your agency performs. There are some very specific guidelines for HH in terms of how and where you can place your equipment and supplies in a patient's home and how you organize your trunk area and what emergency equipment you must carry with you and they will teach you all of this.

Most HH agencies will have a skills checklist and or competency checklists . In addition, to all of that you will have policies and procedures. I cannot stress how critical it is for you to read the policies or have immediate access to them. All of ours our now on line but I used to have them with me for reference. I always would forget the Remicade taper up rates. You will also need to learn how to program and work with they type of ambulatory pumps you will be working with. CADD and Curlin are two brands I have worked with extensively.

Yes, you can perform IV starts and PICC dressing changes with your RN license and do not need anything extra except what your company requires of you. You will of course be held accountable,legally speaking to what the current standard of care is in any given situation. So for example, if the patient is having some s/s/x of thrombosis on the same side as their PICC and you failed to report it and the patient had an undesirable outcome..you would be held accountable. Will you be inserting PICCs? Depending upon where you are located you may see many different brands and types of PICCs and other CVCs and ports. I cover such a wide area I tend to see a lot of brands and types of PICCs both valved and open ended,lots of ports and a few tunneled CVCs. There are lots or resources out there to help.

yes you need to notify your insurance company to tell them you are changing practice areas.