home infusion therapy: a primer pshp 47th annual assembly lawrence carey, pharmd associate chair,...
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![Page 1: Home Infusion Therapy: A Primer PSHP 47th Annual Assembly Lawrence Carey, PharmD Associate Chair, Department of Pharmacy Practice Temple University School](https://reader035.vdocument.in/reader035/viewer/2022070413/5697bfa31a28abf838c9675a/html5/thumbnails/1.jpg)
Lawrence Carey, PharmD PSHP 2015
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Home Infusion Therapy: A PrimerPSHP 47th Annual Assembly
Lawrence Carey, PharmDAssociate Chair, Department of Pharmacy Practice
Temple University School of Pharmacy, Philadelphia
Clinical ConsultantJefferson Home Infusion Service, Philadelphia
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Lawrence Carey, PharmD PSHP 2015
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Conflicts of Interest Disclosure
I have no conflicts of interest to disclose.
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Objectives for Pharmacists
• Explain the concept of home infusion practice.• List three tasks associated with completion of
a successful home infusion referral. • Define the process of care planning.
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Lawrence Carey, PharmD PSHP 2015
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Objectives for Technicians
• Recite the number of home infusion pharmacies currently in operation.
• List four parenteral therapies commonly provided at home.
• List three intravenous catheter types used to provide home infusion therapy.
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Lawrence Carey, PharmD PSHP 2015
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Assessment Question 1
Which of the following patient scenarios would likely not be considered appropriate for home infusion?
a) 23 year old patient with osteomyelitis; needs to complete 6 weeks of antibioticsb) 53 year old ventilator-dependent, in the ICU, on 4 intravenous therapies, including pressors c) 65 year old end-stage cancer patient unable to swallow oral medicationsd) 66 year old ulcerative colitis patient requiring long-term nutritional support
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Lawrence Carey, PharmD PSHP 2015
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Assessment Question 2
Which of the following catheters would likely be considered acceptable to complete 2 more weeks of antibiotics for an endocarditis?
a) PICCb) Chest wall portc) Hickman tunneled catheterd) Triple lumen catheter inserted in jugular without suturing
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Setting The Table
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Definition of Home Health Care
Services provided to acutely or chronically ill, or injured patients at their residence
according to a plan of treatment
prescribed by a physician.
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Definition of Infusion Therapy
• The administration of parenteral drugs and biologicals in a patient’s home, either by the patient, friends/family, or trained nursing staff – Always initiated by a prescription from a qualified
physician who is overseeing a patient’s care – Successful provision of care usually involves a vast
array of clinicians and support personnel
IDSA: http://www.idsociety.org/Home_Infusion_FAQs/#sthash.4d86IznN.dpuf
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Home Infusion Therapy: The Numbers
• Home infusion therapy market– Approximately $9-11 billion
• Number of USA home infusion pharmacies– Approximately 1,500 infusion pharmacy locations
• Market segments grow about 15% each year– This number is changing as infusion suites and
physician offices are doing more business
National Home Infusion Association (www.nhia.org)
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Types of Home Infusion Providers
• Hospital based– Usually larger teaching institutions with a robust
home care presence• Corporate based
– Used to be specialized companies; now expanding to more traditional pharmacy corporations
• i.e., Walgreens Home Infusion
• Independent– “Mom and Pop” pharmacies
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The “Core Four” Major Therapies
• Anti-infectives• Nutrition
– Parenteral– Enteral
• Chemotherapy• Pain management
– Intravenous– Subcutaneous
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Other Therapies Provided
• Hydration, antiemetics, CSFs– Post chemotherapy
• Inotropics – Heart failure
• Immunotherapy – IVIG
• Corticosteroids– Multiple sclerosis
• Chelation– Iron overload
• Inhalation therapy – Anti-infectives for
infections secondary to cystic fibrosis
• Specialty therapies• Catheter care
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The Referral Process
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Patient Selection & Eligibility
• Determine appropriateness of candidacy– Not all consults become patients of a home
infusion service– Lots of factors to consider (i.e., geography)
• Determine primary caregiver – We’ll teach almost anybody
• Assess for type of venous access device (i.e., catheter)
ASHP 2013 Guidelines on Home Infusion Pharmacy Services: www.ashp.org
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Patient Selection and Eligibility
• Before patient is taken onto service, consider– Medical stability– Functional status– Motivation– Reliability– “Trainability”
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Patient Selection and Eligibility
• Once initial assessment done AND patient is deemed acceptable for taking onto your service, consider– Visual acuity and manual dexterity– Available support system– Safe home setting– Appropriate insurance coverage
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Venous Access Devices
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Centrally-Placed VADs
• Peripherally inserted central catheters (PICCs)– Most common, easiest to place
• Tunneled– Broviac, Hickman, Groshong
• Other brands available for specific needs
• Implantable ports– Chest (common) or arm (rare)
• Non-tunneled = non-preferred
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PICCwww.jointcommission.org/.../CLABSI_Toolkit_Tool_1-3_Pictures_of_Central_Venous_Catheters_F-2.pdf
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Tunneled Catheter, Implanted Portwww.jointcommission.org/.../CLABSI_Toolkit_Tool_1-3_Pictures_of_Central_Venous_Catheters_F-2.pdf
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Ambulatory Pumps and Innovative Devices
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Pumps: Moog Curlin, CADD-Solis www.moog.com, www.smiths-medical.com
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Elastomerics: Eclipse, Infusor
www.specials.fresenius-kabi.com/eclipse, www.baxter.com
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Care Planning
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Carey’s Definition of Care Planning
A collaborative, interdisciplinary effort to identify goals of therapy
and a framework to meet those goals.
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The Five Tenets of Care Planning
• Constantly review and revise your approach to providing care for a specific patient
• Identify patient problems• Set goals to resolve these problems• Intervene as necessary • Assessment of whether patient needs are met
Filibeck D et al. AJHP 1999:56:1348-49.
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Miscellaneous Issues
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Paying The Bills
• Accreditations– The Joint Commission– Accreditation Commission for Health Care (ACHC)– Community Health Accreditation Program (CHAP)
• Insurance– Medicare Part B (DME-given therapies)– Medicare Part D (drug only – no supplies or
services)
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Considerations for Your Institution
• Space– Need more than just an IV room
• Staffing– Need 24/7/365 coverage of pharmacists
• A lot of this time is spent on call
– Also need nurses, technicians, delivery drivers, intake/billing personnel
• Capital costs– Pump purchases and rentals are expensive
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Back to Assessment Questions
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Assessment Question 1
Which of the following patient scenarios would likely not be considered appropriate for home infusion?
a) 23 year old patient with osteomyelitis; needs to complete 6 weeks of antibioticsb) 53 year old ventilator-dependent, in the ICU, on 4 intravenous therapies, including pressors c) 65 year old end-stage cancer patient unable to swallow oral medicationsd) 66 year old ulcerative colitis patient requiring long-term nutritional support
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Assessment Question 1
Which of the following patient scenarios would likely not be considered appropriate for home infusion?
a) 23 year old patient with osteomyelitis; needs to complete 6 weeks of antibioticsb) 53 year old ventilator-dependent, in the ICU, on 4 intravenous therapies, including pressors c) 65 year old end-stage cancer patient unable to swallow oral medicationsd) 66 year old ulcerative colitis patient requiring long-term nutritional support
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Assessment Question 2
Which of the following catheters would likely be considered acceptable to complete 2 more weeks of antibiotics for an endocarditis?
a) PICCb) Chest wall portc) Hickman tunneled catheterd) Triple lumen catheter inserted in jugular without suturing
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Assessment Question 2
Which of the following catheters would likely be considered acceptable to complete 2 more weeks of antibiotics for an endocarditis?
a) PICCb) Chest wall portc) Hickman tunneled catheterd) Triple lumen catheter inserted in jugular without suturing
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Summary
• Home infusion therapy is here to stay…and will likely continue to grow– Need to diversify your practice as physician-based
infusion suites are impacting the industry• Motivated, clinically-interested pharmacists
can thrive and collaborate interprofessionally• SOMEONE in your institution is providing
these services….why not you?
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Questions?