Pharmacists and Pharmacy Technicians employed by home infusion companies provide infusion therapy services to patients receiving care in their homes or at ambulatory infusion centers affiliated with a hospital or skilled-nursing facility.
Generally, patients receiving home infusion therapy are able to avoid unnecessary hospitalizations and/or ER visits. Reduced hospitalizations and preventable ER visits improve the health care system and bring costs down, and the savings in one form or another may be passed onto the patient.
Home infusion provider companies comprise of small start-up pharmacy operations that serve patients within a specific geographic radius to large companies that have multiple locations nationwide.
Home infusion patients comprise of adults, geriatric or pediatric patients. Evaluation of whether a patient is a suitable candidate for home infusion therapy may depend on.
- Insurance coverage
- Prescriber specialty
- Drug type – whether it can be safely administered at home or in an outpatient setting
- Vascular access
- Assessment of the home environment – if the patient receives infusions at home
- Patient willingness to self-administer infusions
- Equipment needs
Services offered by a home infusion pharmacy may include but is not limited to…
- Intake coordination, insurance authorization, providing resources for financial assistance, patient education, customized treatments, and delivery of the final product to the patient.
- All the above may be conducted from a single pharmacy location which is usually the case with large home infusion providers.
- Infusion therapies may be administered via intravenous, subcutaneous, intrathecal, intraosseous, epidural, or enteral routes that may include tube feedings through NG (Nasogastric), PEG (Percutaneous endoscopic gastrostomy), G-tube (Gastrostomy) or J-tube (Jejunostomy).
- Specialty pharmacy services may also be provided for disorders like cystic fibrosis, rheumatoid arthritis, HIV, hepatitis, transplant care, oncology, and more.
- Other services may include dosing and maintenance of antibiotics such as Vancomycin and Aminoglycosides, Immunoglobulin therapy and monitoring, PN dosing and maintenance.
- Providing respiratory equipment and clinical respiratory services.
- Providing medical equipment such as infusion pumps and IV supplies to nurses such as dressing kit changes, IV start kits, etc.
- Providing compounded or ready to use medications to be infused by the patient or nurse.
Generally, the Home Infusion Pharmacist is responsible for…
- Providing clinical pharmacy services to patients, nurses, and physicians.
- Prescription order entry.
- Compounding medications.
- Hiring KEY personnel such as Pharmacy Technicians.
- Supervising personnel.
- Communicating with Physicians regarding therapy and clarifications and recommending dose adjustments if required.
- Monitoring therapy.
- Communicating with home infusion nurses regarding equipment, supplies, and answering any medication-related questions.
- Conducting patient assessments, monitoring regimen adherence, answering patient questions regarding therapy, resolving delivery issues, or medication-related issues.
- Conducting inventory per the facility P&P. Addressing drug shortages and recall issues.
- Training personnel.
- Maintaining logs and other paperwork per state/federal guidelines.
The list above is NOT all-inclusive but lists the primary responsibilities of Pharmacists.
If the Pharmacist is also the Pharmacist-in-charge then he/she would additionally be responsible for …
- Maintaining and updating SOP’s.
- Maintaining and updating P&P manuals.
- Making sure all paperwork such as training logs, equipment certification logs, validations, inspection reports, inventory logs, drug recall/shortage logs, etc. are in compliance with state and federal laws.
- Creating emergency preparedness plans.
- Instituting medical surveillance programs and more.
Pharmacy technicians may be responsible for providing the following home infusion services such as.
- Equipment maintenance and calibration.
- Ordering and inventory.
- Product receipt and stocking.
- Coordinating shipping and delivery.
- Intake and insurance authorizations if there isn’t a dedicated department for it.
- Answering phone calls.
- Organizing and filing paperwork.
- Training Pharmacy Technician hires.
- Conducting non-clinical patient assessments.
Again, the list above is not all-inclusive but lists the primary responsibilities of Pharmacy Technicians.
Testimonial: "I highly recommend " [The] Introductory Home Infusion Course" for those who intend to specialize in Home infusion Compounding. Very informative and well put together material. Excellent addition to Sterile Compounding Course."
Testimonial: This course provided information that can not be found on the Internet. If you are looking to get into home infusion, this is the course for you. The information and knowledge I gained from this course made me a competitive candidate for my home infusion position.
Testimonial: The Home Infusion course was very comprehensive and easy to understand. The instructor made sure that they are giving the information in a way that won't make me confused. Thank you Mayur so much for this great course!
Testimonial: The material and slides are very helpful. Mayur answered my questions thoroughly with good examples from the practical work settings.
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PRE-REQUISITE KNOWLEDGE REQUIREMENTS
If you haven’t guessed it, it’s knowledge of sterile compounding. The goal is to be able to quickly integrate into the workflow. The compounding course (optional) PLUS the home infusion guide you receive when you sign up for this course will prepare you for this role regardless of whether you’re a Pharmacist or a Pharmacy Tech. You’ll know what to expect and be more knowledgeable than the average applicant.
Information from the home infusion guide and the sterile compounding course will enhance your skillset and give you insider knowledge of the sterile compounding world.
EXAMPLES OF INFUSION THERAPIES SUPPORTED BY
HOME INFUSION PHARMACIES
Most Infusion Pharmacies will offer some or all of the following if not more.
- Anti-infective therapy that can be safely administered at home or in an outpatient setting.
- Nutrition support that includes enteral and parenteral nutrition care for acute or chronic conditions.
- Inotropic therapy for heart failure patients.
- Immunoglobulin therapy.
- Hemophilia and Von Willebrand therapy.
- Therapy for neurological disorders such as muscular dystrophy.
- Therapy for chronic inflammatory disorders.
- Specialty therapies for disorders like cystic fibrosis, rheumatoid arthritis, HIV, hepatitis, transplant care, oncology, and more.
HOME INFUSION PHARMACY AND ON-THE-JOB TRAINING
Before you’re hired or on the first day at the job, you may be asked to take a test to assesses your knowledge about sterile compounding and compounding related math questions. This should not pose a problem if you studied the course thoroughly and passed the final exam.
Here’s A Simple Example
Pharmacy received an order for Daptomycin (cubicin) 6mg/kg q 24 hrs. to treat S. aureus. The patient weighed 350 lbs. 1 vial of Daptomycin contains 500 mg. How many vials do you need?
The Practical Need-To-Know Aspect If You Really Had To Compound Daptomycin For Delivery (Cubicin)
If you were asked to compound the Daptomycin (Cubicin) you would need to know whether you’re reconstituting Cubicin or Cubicin RF. Look at the prescription order carefully.
Cubicin is available in a 500 mg vial containing powder and must be reconstituted with 10 mL of 0.9% sodium chloride, however, Cubicin RF MUST be reconstituted with 10 mL of sterile or bacteriostatic water.
Once you’ve figured out the diluent you’ll be using, you would need to know what the final concentration needs to be. In most cases 50 mg/ml for this drug. Final concentration information can be obtained from the prescription order if available or the medication package insert.
After reconstitution, the solution must be left to stand for 10 minutes then gently swirled to avoid foaming and since that takes a while you would have to multitask and complete other tasks at the same time. (Again, refer to the drug package insert for special or specific instructions).
If you were in a home infusion setting you would also need to know how a particular drug is usually administered by the nurse in a home setting.
For example, antibiotics may be administered to home infusion patients via disposable elastomeric pumps. If this was the case then you would also need to know what the final concentration of the Daptomycin (Cubicin) needs to be so it remains stable in the pump. (Available in the Pharmacy’s SOP. Trissel's handbook of injectable drugs will also list this information)
The final concentration will most likely differ from the 50 mg/ml shown above. Usually, 20 mg/ml if it is to be used in an elastomeric pump.
If a pump will not be used then how will it be administered by the nurse? Via gravity infusion or IV push?
If IVP then you would need to draw the dose into a syringe and label it. If given in a mini bag it would need to be further diluted in 50 ml of NS and labeled. (Information on the method of administration would be on the Rx order, if not, verify it by calling the MD/Nurse. Dilution info could be obtained from package insert, pharmacy p&p, sop or from pharmacy reference materials such as Trissels handbook of injectable drugs, etc.)
You would also need to know how the drug will be infused? For example, will it be infused via a peripheral, mid or central line? Again, this information is available in the references available in the Pharmacy and the cheat sheets available in the pharmacy that your PIC may provide you with. As a last resort call the nurse to find out, although you shouldn’t need to.
Depending on the method (peripheral, mid or central line) you would also need to know which supplies to send with the final CSP and relevant instructions for storage, administration, infusion rate, time, etc.
Sounds like a lot to digest for just one drug, right?
It is but if you’re proactive and can manage to be a sponge and absorb the on-the-job-training as much as possible you’d be ready to do this on your own in no time. Sign up for the home infusion course to learn more.
Realistically, for frequently dispensed drugs, the supplies and instructions for the nurse would be saved on the computer as a template and automatically print with the delivery ticket if the Pharmacy is using CPR+ which is commonly used in home infusion settings although there are other software vendors as well.
However, relying 100% on the computer is never a good idea, the system may crash or other unforeseen problems may arise so knowing which supplies and instructions if any must be sent with each order without relying on the computer puts you in a better position.
In other words, you should be able to “think your way through the therapy” and use references as needed. However, if you don’t have a sterile compounding background then signing up for the online sterile compounding course is HIGHLY recommended. Sign up today and get the home infusion course for 50% OFF for a limited time.
The home infusion guide contains the following additional topics covered in detail.
- Vascular Access Devices
- Commonly used supplies (includes pictures) and pre-meds
- How to determine which supplies to send
- Tubing sets (includes pictures)
- Commonly used pumps(includes pictures)
- All about IV fluids
- Job search and interview tips
- And More…
NOTE: If you don't have a sterile compounding background then enrolling in the IV certification course OR signing up for the standalone program is HIGHLY recommended.
You must have sound knowledge of sterile compounding basics before enrolling for the home infusion course. The infusion course contains condensed need-to-know information.
TESTIMONIAL FROM A SATISFIED STUDENT
The Home Infusion course was very comprehensive and easy to understand. The instructor made sure that they are giving the information in a way that won't make me confused. Thank you Mayur so much for this great course!