Question about IV therapy in the home

Published

I have a question that hopefully someone who practices in Florida can help me with, or maybe anyone can point me in the right direction. I am very frustrated. First, some background info. I have just been promoted to the position of Assistant Director of Nursing, and one week later my DON jumped ship. We have a patient who recieves monthly IVIG infusions. What I am reading in Florida law is that an LPN cannot administer blood products to a patient. And I am also under the understanding that IVIG is a blood product. I have scheduled this patient with an RN, but the problem is that the patient followed an LPN from another agency, and this nurse has been administering his infusions the whole time. He was scheduled with the RN, who called and tried to set up the appointment, and the patient got very irate and manipulative and threatened to go to another agency BLAH BLAH BLAH. SOOO.... My administrator/owner, instructed the LPN to go out and do the infusion, stating that his expert says this is perfectly fine. Problem is, neither the owner of the agency or the expert's name is on MY nursing license. I have asked for someone to just show me in the law where this is okay, and I will leave it alone, and noone is able to. I have voiced my disagreement, but apparently my opinion doesn't matter. Anyway my question is, 1. Does anyone feel it is legal for an LPN to administer blood products in the home and 2. If the answer is no, who will be held responsible if the agency is allowing this to happen. I am the one who is supposed to be upholding the Nurse Practice Act, but I have been trumped. Maybe I am being too stubborn about this, but it bothers me, and once I get some straight answers, I think I will be fine. I could be wrong, and I hope I am, but I just would like to see it in black and white. Thanks!

Up Vote Up Vote ×

I don't know the answer to this. I would look and see if there is anything about it in the Florida nurse practice act. Regarding IVIG though. There is a pending case here about a patient who suffered a stroke from this infusion and the HHA is being sued. It sounds like they were at fault. To save time they infused the medication faster than recommended and took the filter off of it in order to do so. When the patient was not doing well, vitals were not taken for over an hour. When vitals were finally taken, they don't match on all of the paperwork. Be very careful with this type of infusion and make sure to tell your nurse doing the infusion to document and perhaps even give an inservice from the pharmacy on this product. There is more of it being seen in the home and not too many home care nurses know much about it.

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

show this to the administrator:

fla lpn regs:

64b9-12.003 aspects of intravenous therapy outside the scope of practice of the lpn.

(1) aspects of intravenous therapy which are outside the scope of practice of the licensed practical nurse unless under the direct supervision of the registered professional nurse or physician and which shall not be performed or initiated by licensed practical nurses without direct supervision include the following:

(a) initiation of blood and blood products;

(b) initiation or administration of cancer chemotherapy;

© initiation of plasma expanders;

(d) initiation or administration of investigational drugs;

(e) mixing iv solution;

(f) iv pushes, except heparin flushes and saline flushes.

(2) although this rule limits the scope of licensed practical nurse practice, it is appropriate for licensed practical nurses to care for patients receiving such therapy.

specific authority 456.013(2), 490.004(4) fs. law implemented 456.013(2) fs. history-new 1-16-91, formerly 21o-21.003, 61f7-12.003,59s-12.003, amended 4-9-98.

http://fac.dos.state.fl.us/faconline/chapter64.pdf

--------------------

the adminstrator having allowed the patient to control his/her company, has opened themself to loosing all monies involved in this case if this chart gets audited by the insurance company or state auditors who love to find this type of error....opens the agency up to an audit of every chart and loss of state license if other discrepencies found.

make sure you document in writing your concern to the administrator and have documentation in your private home files.

Up Vote Up Vote ×
Specializes in MS Home Health.

I have never seen IVIG done by an LPN anywhere. I hope your dialing the new agencies phone as I am posting...

renerian

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

What is IVIG?

IVIG refers to Gamma Globulin which is the chemical portion of blood that contains immunoglobulins or antibodies. They are produced by Plasma Cells and are an important part in the Immune Response. There are five different classes of ImmunoGlobulins: IgG, IgA, IgM, IgD, and IgE.

Gamma globulin has immunomodulatory, and immunoprotective properties, that have led to clinical trials in a wide range of non-infectious, immune-mediated diseases.

See:

http://www.primaryimmune.org/pubs/infusion_log.pdf

Infusion Protocal:

http://www-nmcp.med.navy.mil/nursing/procman/IVIG.doc

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.
I hope your dialing the new agencies phone as I am posting...

They admit to being unaware of regs and change their tune or place resignation in their hand for YOUR license is on the line as ADON for not knowing the scope of practice of LPN's.

Up Vote Up Vote ×

I would like to expound on this subject some more, if I may. Would it also be okay for the RN to come in, begin the infusion and leave the patient in the care of the LPN, to return several hours later to discontinue the infusion. I am not sure if this scenario changes the rules or not. Like I said, I am just trying to get to the bottom of this. The infusion is monthly and I have about 25 more days to go!!!! Thank you all for the great information above!

Up Vote Up Vote ×
Specializes in Vents, Telemetry, Home Care, Home infusion.

Having 15 years homecare infusion in PA/NJ/DELnever seen LPNs utilized.

These patients often need IV Push meds to be given, often IV Benadryl and occasionally Lasix. PA and FLA does not permit LPN's to give IV push meds except heparin flush.

My understading of "DIRECT SUPERVISON" is an RN being available to intervene should problem occur AND being responsible for actions of staff.

IVIG infusions can cause anaphylaxis type reaction needing IMMEDIATE response. Any knowledgable RN experienced in IVIG infusions would not want to take on responsiblity should something happen---and 1 out of 5 infusions often calls for more meds, change in IV rate etc.. Blood products require RN to be directly available ---not 30min to one hour away as in homecare.

I'd have no problem with starting IV fluids on a patient with Hyperemesis gravaderum/dehydration and having LPN monitor and D/C IV after 6-8hour infusion.

If BON permitted LPN's administering IV infusions, would be different story. Still not comfortable with this type of blood product being administered by LPN. I'm not willing to give my license away.

Up Vote Up Vote ×
+ Join the Discussion