Home Infusion

Posted by Christine Rabah at Thursday, January 19, 2012

So the past 2 months have been crazy- I think my classmates summed up Midyear very well, so I won't get into that. I chose to have December as my off month, but didn't get to do much relaxing. From Midyear, to thank you cards, to applications & letters of intent, to planning my wedding on top of all that...whew is all I gotta say!

Fast forward to January..My current rotation is at HomeMed home infusion, which is fulfilling my "nontraditional rotation" category. Nontraditional it definitely is! I can confidently say that being here (especially the first week) was the most I've ever been out of my comfort zone. HomeMed consists of pharmacists, nurses, dietitians, and pharmacy techs working together to fill orders for patients to administer at home (either administer themselves or by one of the nurses). The bulk of the orders consist of antibiotics, chemotherapy, and total parenteral nutrition (TPN). TPN is used when patients don't have a well-functioning gut, so they get their nutrients and lipids intravenously.

I've gotten to shadow every part of the process. I've seen referrals come in for home infusion in intake, then they come to the pharmacist on whatever team the patient is assigned to (a team consists of a pharmacist, tech specialist, and tech associate) who verifies the order. it either gets compounded in the enormous clean room or picked in the shipping area, where another pharmacist will check the compounded product and the medications to be shipped. Many deliveries go out per day. HomeMed also provides the Cancer Center with their infusions. Once the patient receives the medication, they can administer themselves or have a nurse come to the home for administration. Patients can be taught to give themselves the medication if they have some type of access site (port, PICC line, etc).

Some medications get delivered to the hospital to give to the patient just before they are discharged. In these cases, there is a HomeMed training team at the hospital consisting of nurses who will meet the patient in their room and show them how to hook up their infusion. I was able to go to the hospital one day to shadow this process. There can be many challenges with home infusion. One of the patients I shadowed was an infant who needed TPN. His mom couldn't speak English, so all translation of how to do the infusion had to go through the dad, who would not be home during the day to make sure it gets done correctly.

I was also able to go with a HomeMed nurse (separate from the hospital's training team) to a patient's school so he could get his infusion. This patient was one that I had seen on a previous rotation, so it was really cool to see what happens after discharge. Other activities I've participated in were presenting a journal to the HomeMed pharmacists, a review of enteral nutrition (including seeing all the different tubing devices) with a dietitian, and a review of types of access lines with a nurse. I am currently working on a presentation to present during a pharmacist meeting on the importance of double checks of medications.

This rotation has been very different than what you think of "typical pharmacy," but interesting nonetheless.