What happens if IV med does not finish on time?

[umharhar]

Hi. I'm a new grad working for home health.

I'm currently seeing this pt for IV infusion Q12H for 14 days.

We're almost half-way done and I've instructed and validated patient and caregiver's competency for IV infusion so they can infuse the evening dose.

The problem is everytime I'm not there...they seem to have problem with IV med infusing around 30 minutes longer or shorter than it should which is 2 hrs...

I checked after they had this problem for the first time and they were doing everything okay.

Pt is worried that he's not getting his IV infusion correctly because this is his second time for getting IV infusion for the same diagnosis.

When I do the infusion, I always finish the IV med on time so Pt wants me to come every time which is twice a day but my agency wouldn't let me and tells me I need to teach them more...

So does infusion time matter critically for proper IV infusion? I asked the agency if this would be considered med error but they said it's not...

[jdub6]

How is that possible IVRUS? Home Health agencies follow CMS guidelines for billing through fiscal intermediaries.

They recieve pps payements for episodic care over a case mix rate. This has absolutely nothing to do with medications or supplies to deliver such medications.

All IV supplies and medications are provided via an infusion pharmacy and billed through Medicare part D. Home Health is paid through Medicare A or B.

So I am confused on what you are talking about.

Umharhar stated he was a home health new grad not a pharmacist or infusion nurse.

Infusion companies where I live are more than happy to use elastomeric devices.

In some areas (including mine) the infusion company will send a nurse to do pt teaching as well as manage the IV (restart PIV when needed, dressing changes on PICC etc). The OP could be a home infusion nurse working for the infusion company and I believe that it what the PP you quoted is talking about.

What you said about home care billing is true for standard home care but not for all types of agencies that employ home health nurses. For example home hospice care is reimbursed per pt per day based on level of care BUT the hospice company is expected to provide aka pay for all meds and equipment-so in that case the hospice nurse could easily run into a mgr who will not authorize ordering a certain type of infusion for a pt due to cost.

Also as i said sometimes the infusion pharmacy will provides the med to a general home health pt, the pharmacy bills the pts insurance for the med and the home nurse is responsible for the infusion management plus all other home care ie wound care with the home health agency billing for nursing care and having nothing to do with pharmacy billing. In other cases the pharmacy sends their nurse to manage the infusion and bills for both while a home care company nurse does everything else and bills for their nursing services separately, and in still other cases the home health company contacts with a home infusion company which provides a nurse to manage the infusion but contacts with a pharmacy to provide the infusion through the pts insurance and bills their services separately. And in these scenarios you have multiple options in terms of which agency obtains the physician orders for the infusion- sometimes it is the agency that is billing for the actual product and sometimes it is not.

If anyone is still with me i do apologize that this had nothing to do with the OP. I believe IVRUS has addressed that pretty well.

[BreezyFlorida]

I am having the same problem, it's my first time using dial-o-flow...the patient is getting an iron supplement infusion in a 250ml bag that is supposed to infuse over 2 hours at 125 ML and hour. After close to 3 hours half the bag was still left. I calculated the drop per minute at 32 and was counting them but it just wasn't infusing. The patients family think I'm incompetent, I am really stressed out...can I increase the rate? Are IV bags ever overly full?

[KelRN215, BSN, RN]

I am having the same problem, it's my first time using dial-o-flow...the patient is getting an iron supplement infusion in a 250ml bag that is supposed to infuse over 2 hours at 125 ML and hour. After close to 3 hours half the bag was still left. I calculated the drop per minute at 32 and was counting them but it just wasn't infusing. The patients family think I'm incompetent, I am really stressed out...can I increase the rate? Are IV bags ever overly full?

What does the label on the bag say? Have you called the infusion pharmacy about your issue? What size is the patient's PICC? I have always found dial-a-flow tubing to be crap in pediatrics where kids sometimes have 3 Fr PICCs or smaller but dial-a-flow was a last resort for these kids/used when it was pretty much the only option. There shouldn't be a large amount of overfill in this situation.

The OP is very old but I just want to mention, since it was brought up a couple times, that sometimes elastomeric pumps are not an option for the specific drug prescribed. Zyvox (linezolid) comes in a ready to use bag from the manufacturer and is a room temperature med. Room temperature meds cannot be put in elastomeric pumps. At least that's what my Pharmacy colleagues always told me when I worked in home infusion. I never had to send anyone home on IV linezolid in 3 years at that job- the providers by and large changed it to PO prior to discharge- but once or twice I had to a fractional dose of IV flagyl (which also comes in a RTU bag and is a room temp med) and had to teach parents to draw up their child's dose from the bag and then administer it on a syringe pump. Usually once the provider heard that this was the only option for their med of choice at home, they looked into other options. I only remember doing IV flagyl twice on a child and once was, I'm convinced, a Munchausen-by-proxy case where the child's mother convinced the Immunologist to prescribe it to him outpatient even though the Infectious Disease team was trying to take the child off all IV antibiotics.