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

[skydancer7]

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!

[Esme12, ASN, BSN, RN]

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

I am not so sure I'd be calling my malpractice insurance for advice.

[KelRN215, BSN, RN]

I access ports and give IV meds every day in home care so that's not an issue. Patients can be taught to self-administer IV fluids- I have patients at home on all kinds of IVs, antibiotics, fluids, TPN, etc.

A home infusion company can be arranged to deliver normal saline bags, saline flushes, IV pump, heparin flushes, huber needles, access kits, etc and then your MDs can prescribe the patient the additives to the normal saline. You do teaching visits in clinic to show him how to add them to the bag and set up his infusion. It's done every day.

[caliotter3]

The issue, I believe, is not that IV therapy itself is called for in the home environment, it is whether or not the infusions are approved and/or under a proper order. In the case I mentioned, the drug was not approved by the FDA. The patient paid for the drug, and obtained it, from Europe. My employer would take no responsibility. The infusion company (or other home health agency), and its employee, obviously saw no problem with it. I have had patients take all kinds of concoctions and such orally, that are signed off by the doctor on their 485. As long as their physician signed the 485, I complied.

[nur18]

All my patient with IV are seen by the infusion nurse. The nurse make the initial visit and either teach the patient, family, or both. When they can perform the skill the nurse will visit ones a week.

[nur18]

That once a week

[KelRN215, BSN, RN]

The issue, I believe, is not that IV therapy itself is called for in the home environment, it is whether or not the infusions are approved and/or under a proper order. In the case I mentioned, the drug was not approved by the FDA. The patient paid for the drug, and obtained it, from Europe. My employer would take no responsibility. The infusion company (or other home health agency), and its employee, obviously saw no problem with it. I have had patients take all kinds of concoctions and such orally, that are signed off by the doctor on their 485. As long as their physician signed the 485, I complied.

Yeah, that's why I said they teach the patient to reconstitute the fluids himself and add the additives. I've taught patients/parents to do it with TPN.

There is a clinic in Houston- The Burzynski clinic- that advertises cures to all kinds of cancers that failed previous treatment. For many years, the clinic refused to work with the FDA. They put their patients on a continuous infusion of a drug called "antineoplaston"- because of the history of it, most providers outside this institution won't touch it. So, the patients are taught to manage the infusion, change the bags, etc. Patients will still be able to provide providers in their home communities to deliver things like port access kits, saline flushes, etc. We've managed patients with this infusion where I've worked before- we couldn't touch the actual drug or do anything with it but managing the line was not a problem. If the patient needed labs or a huber needle change, for example, the parent needed to disconnect and reconnect the infusion before and after but we did everything else.

Many drugs are not FDA approved in children so I give stuff to patients for whom it's not approved on a regular basis.

If I were the OP's patient, I'd want to do the same thing. Fluids can be administered as home.

[skydancer7, BSN, RN]

Thanks for the input, all.

Insurance does cover some things for some patients. And I personally am happy to pay my naturopath out of pocket vs seeing my Western doc for a lower fee, simply because I get PROFOUNDLY better health care and results via my naturopath. But that is not the issue at hand...

My concern is that yes, as a nurse, I cannot find enough information on whether some of this stuff is safe. There is no naturopathic RN IV drug guide to guide me as to proper protocols; I am relying on the judgment and training of the NDs I work with. So, it makes me extremely nervous to send this out of our clinic, out of our sight... I think we could be held liable if something happened and the judge asked why the patient was sent home with IV supplies, vials of IV vitamins, etc... this is not like there is an established protocol with proper dosages that any nurse can research and confirm. I really am considering quitting this clinic altogether because I am the only nurse there and simply do not feel safe; there is no back-up, and no established protocols I can rely on. I love some parts of naturopathic medicine and that's why I wanted to work there... but this is just making me too uncomfortable.

I am considering giving my boss and/or the patient some numbers to home health people and see how far they can get with that, and just walk away. Luckily, I have a second job... oi...

[OCNRN63, RN]

If the patient is harmed in some way from this, or any other treatment for that matter, you could be on the hook legally. You can get another job, but you can't get another license as easily.

Do you have malpractice insurance? If you do, can they advise you?

[canoehead, BSN, RN]

I think that the patient needs to get his scripts for meds and supplies, and go through a pharmacy or medical supply company. Pick them up, then what he and his RN friend do at home is completely at their own risk.

[skydancer7, BSN, RN]

Canoehead, thank you for the post that finally got my anxiety to settle down a little! What a perfect solution... thank you, thank you. I guess it is a matter of saying, that's not a service I provide, but here are some scripts from the doc and some phone numbers of where you can order things etc. Brilliant. I think this will work. Meanwhile I start working on my exit strategy...