Patients want to bring port and IV supplies home...???

[skydancer7, BSN, RN]

Hello,

I work at an outpatient integrative clinic where we do IV therapy. I have a patient who lives a long way away (a couple hours) and they are asking if they can have us order them IV supplies (vials of b-vitamins and minerals, saline bags, needles, syringes, port access kits, huber needles et....) and have their RN "friend" (granted, she is very experienced and licensed yadda yadda...) mix and administer the IVs in their home. This way they would not have to commute in order to get their regular IV therapy. I want to help them out but I am having some major hesitations. They don't seem to understand how complicated it is to set up an IV therapy area; there are 30 or so supplies that I use, not to mention how to mix things up. Also, if something goes wrong, even if they have signed a waiver, I would feel responsible.

I have a bad feeling about this and have expressed as much to the patient and my boss. However, I am wondering if there is something in writing, some law I can point out. It can't be legal to order IV therapy supplies, send them home with a patient, have them sign a waiver, have a skype session to tell the nurse how I mix up the bags, and hope nothing goes wrong!!! I am getting heavy push-back from the patient and my boss is trying to find a way to make it work. Please help? Advice?

Thanks so much!

[Rose_Queen, BSN, MSN, RN]

What about a referral for home infusion services?

[caliotter3]

Yes, get the doctor to order all of this and there should be no problem.

[skydancer7, BSN, RN]

Rose, perhaps; though I doubt a home infusion service is familiar with or willing to administer: these are vitamin/mineral therapies at a naturopathic clinic, safe but not "FDA approved"... things like Myer's cocktail etc. Worth looking into though... thank you!!

[skydancer7, BSN, RN]

Yeah I think if the doctor orders all of this, and it's out of my hands, that's fine...

[OCNRN63, RN]

As a former infusion nurse who did home care, there is no way I would administer "cocktails" that were not FDA approved. If the patient really needs these infusions, s/he'll find a way to make it work to get to the clinic. I doubt a home care company will accept this sort of patient because more than likely there will be reimbursement issues, not only for the meds, but for the nurses that would come out to do the infusion.

[caliotter3]

I once worked a case where the patient was receiving a nonapproved infusion. He was tended to by an RN who came from another agency. My employer forbid me from being in the room when this was going on and from documenting on it. I questioned whether or not I should be documenting on the site condition, and they told me to make the minimum entry and to immediately call if anything seemed amiss. So there are agencies and caregivers out there who will cooperate with nonroutine procedures.

[cayenne06, MSN, CNM]

As a former infusion nurse who did home care, there is no way I would administer "cocktails" that were not FDA approved. If the patient really needs these infusions, s/he'll find a way to make it work to get to the clinic. I doubt a home care company will accept this sort of patient because more than likely there will be reimbursement issues, not only for the meds, but for the nurses that would come out to do the infusion.

Yeah. . . I know this is not the topic of this thread, but quack remedies like this drive me up the wall. I am sure your patients are paying out the nose for these services since they are likely not covered by insurance, and to me that is unethical. I know people like to talk about "big pHarma" and how they are just in it for the money, but naturopathic doctors (and other "alternative" providers) seem to have no qualms prescribing supplements/treatments that they just so happen to sell in the clinic. Conflict of interest, to say the least.

http://www.sciencebasedmedicine.org/a-closer-look-at-vitamin-injections/

[NRSKarenRN, BSN, RN]

Most "outpatient integrative clinic" care is provided on a private pay fee basis. Some home infusion providers would love a private pay client IF prescription for medication is within established parameters for medication and ordered by a licensed physician.

Another option is both a compound pharmacy which would mix medication product + IV infusion/DME company to supply IV catheter supplies with RN "friend" doing administration. Takes some time to set this up.

In the late 80's, my MIL had port-a-cath that only 2 nurses in outpatient clinic new how to access, so if they were off +she needed IV meds/transfusions I would access her site within 24hrs prior to clinic appointment. Have provided IV vitamin cocktails, administered IVIG and blood transfusions in the home so alternate IV treatment can be arranged---just takes time + learning how to setup. PM me if I can be of help.

[OCNRN63, RN]

Yeah. . . I know this is not the topic of this thread, but quack remedies like this drive me up the wall. I am sure your patients are paying out the nose for these services since they are likely not covered by insurance, and to me that is unethical. I know people like to talk about "big pHarma" and how they are just in it for the money, but naturopathic doctors (and other "alternative" providers) seem to have no qualms prescribing supplements/treatments that they just so happen to sell in the clinic. Conflict of interest, to say the least.

A closer look at vitamin injections « Science-Based Medicine

Actually, when I looked up "Myer's Cocktail," the search engine sent me to the "Quackwatch" site. If it's not harming the patient and if he's willing to pay for the services, then it's his dime. In my area, there are no naturopaths, so this sort of situation would be a rare one.

[dream'n, BSN, RN]

I wouldn't participate in this. The treatment is not evidence-based and who is going to verify that the RN "friend" has a clean/clear license. I'm like sorry Charlie, no can do. And who is going supply the equipment, including NS which is considered a medication. If they want to go the Alternative Med. route let them pay for it in cost and inconvenience. Bet they're upset that insurance/medicare won't pay for it.

Irritating, when some poor people can't even get the most basic of care in the US.

[Kooky Korky, BSN, RN]

What's unethical - that Big Pharma and the billionaires behind it have a stranglehold on what US doctors are able to offer patients?

In Europe, particularly Germany last I checked about 15 years ago, patients are much freer to get both Western medicine and holistic, whole body treatments.

Don't forget that slash/poison/burn doesn't always cure either.

Yet that is the choice patients in America have; the only choice if they want insurance to pay and possibly find trouble for doing something illegal.

Did you know that a former head of the FDA (about 20 years ago, not sure who) took his own wife to Europe for "quackery" care rather than have her go bald, puke herself dry, and still die?