Remicade / Immunoglobulin IV in home health setting?

cookie102 · Mar 2, 2007

i have not administered remicade in the home, but on several occasions IVIG, there is a protocol for administering at home and the IV company that supplies it to you will be able to provide it, tho it is not complex adm, it can be extremely long visit depends on how the pt is tolerating it....has been up to a four hour visit and as short as 2 hour!!!

CardioTrans, BSN, RN · Mar 3, 2007

I have never given Remicade, but have many times given immunoglobins....... One in particular is a drug given for Alpha-1 antitrypsin deficiency. The company that makes the med has their own pharmacy that supplies the infusion to the patient. They sent 2 wks worth of med at a time, each 2 wks I had to call them and give them an updated weight on the patient, and they adjusted the dose before they sent it.

With all IV therapy I have done in the home, the infusion company supplying the medication adjusted the doses if they were weight based, or if it was TPN. Even on Vanc, Nafcillin etc......... they adjusted the dose off of the lab work values before they sent it to the patient.

homehealth43130 · Mar 4, 2007

We have given both IVIG and Remicaid in the home. We never first dose and an RN must be present the entire visit. We don't do much of thoes infusions anymore since the local hospital opened an ambulatory infusion center. We try and steer those referral there now, because it was not very cost effective for us to pay an RN for a 6 hour visit.

CRNI-ICU20 · Mar 4, 2007

IV Home Health infusion of Remicade and other immuno-triggering drugs are a very high risk for anaphalaxis. I infuse Remicade in a doctor's office, and I have seen the early warning signs with first infusions....however, Remicade and Orencia, and other drugs like this have the ability to cause reaction with ANY infusion....so you could be fine with your first two or three doses, and then develope a reaction...and believe me, you don't want to be the lone nurse, in a remote housing developement with a hospital 10-20 mins. away! I believe that Centocor, a division of J&J, who makes Remicade, recommends controlled dr. office environment, with a dr. present at all times with the infusion....otherwise, the RN/Infusionist bears the burden of treatment and subsequent fallout of the reaction all on his or her shoulders alone.....I would think that this would be not within the recommendations that even a home health agency would embrace. I would question the legalities of this right off the bat, esp. if the company recommends otherwise....sounds like a lawsuit waiting to happen....not to mention a devastaing mishap with a patient....I wouldn't put myself in that position.....

I know that Medicare doesn't re-imburse patients for Humira and Enbrel for IM injectable anti-arthritic drugs.....so it seems odd to me that Medicare would cover home infusion of Remicade, (if it does) when the drug company that makes it recommends 'controlled setting' infusions.

What does your director of Home Health Infusion say?

What do they base their statement on?

I would be curious to know what is generating the standard.....whether it is the saving of health care dollars, patient convenience, or whether it is SAFETY for the patient....

homehealth43130 · Mar 4, 2007

Medicare didn't pay for this - the patient's insurance covered the cost of the drug and the nursing visit. There was not a physician office that would infuse the drug at the time we gave the remicaid - about 4 years ago. Also the patients physician was the one to give the order, we cannot do any procedure without the approval and order of the physician. Most physicians in our area do not do infusion in the office. Which is one of the reasons the local hospital opened an ambulatory infusion center. Yes we are rural, and there were emergency drugs available in the home with standing orders for use. This patient lived about 30 min. from the closest hospital, and the EMS system was volunteer. There was a strict protocal for infusion, vital signs and documentation. We never had any problems with this patients infusion, which doesn't mean much as each patient is different, but that was our experience.

teaka · Mar 4, 2007

I'm curious to know if the insurance rate for these visits were more than the typical reimbursement, given the fact that these visits are 2 or more hours for the nurse. With the potential risks to the patient and probably poor reimbursement to the agency, I'm surprised to hear that it is given in the home frequently.

AmPmRnoncall · Mar 18, 2007

I have administered blood, cerezyme, IVIG, IV steroids, Remacaid, in the home. Sometimes the closest hospital was 40 minutes away with a rural volunteer fire ems. Clients should always have had there first dose in the hospital and not be a high canidate for reaction. Always have benadryl, epi and normal saline and a very patent IV line.

akvarmit · Mar 26, 2007

It is an acceptable practice to infuse certain medications in the home setting. Medicare and private insurances both may pay for this service, and there are many IV companies who's only work is to support these patients and provide the medications.

I have given IVIG, many various antibiotics, IV push lasix, runs of solumedrol, etc in the home setting. We also access ports, d/c picc lines, d/c chemo infusions started in the out patient office. We have appropriate approved protocols for each type of med. I am at a hospital based agency and we just passed our JACHO visit :) so this is not some underground secret renegade service we provide.

Home Health provides a very valuable service to these patients - in our area there is no ambulatory infusion place to go to, we do it all out in the field.

Dawn in PA

DutchgirlRN, ASN, RN · Apr 4, 2007

The agency I work for refuses referrals for either. Remicade due to reactions and Immunoglobulin due to the length of visit required. The agency I used to work for would take any referral and were per visit so they didn't care how long the visit would be. The longest I would accept was 2 hours unless they agreed to pay per hour past the first 2.

I had one patient that got a 2 day infusion of Immunoglobulin every 6-8 weeks for chemotherapy induced peripheral neuropathy. The patient is in his late 30's. The doctor ordered that the wife could administer the Immunoglobulin but the IV needs to be started by HH nurse since the wife cannot. The wife feels totally comfortable with this arrangement and have been following this protocol for 5 years both in CA and now in TN.