di: home infusion/IV pharmacy/mental health?pt 1

After my week in outpatient counseling, I had my last rotation of 2012! This week is split between three different locations ? where you only spend 1 or 2 days in each place.

Since I was in three different places, I?m going to split this into two posts (so it doesn?t get too long). This is post 1.

The first rotation was 2 days long and was at Walgreens Home Infusion. This is a home IV pharmacy that provides IV medications and nutrition support to patients in their home environment. This is a very profitable business because it saves patients (and insurance companies) to not stay in the hospital for extended amounts of time if they need to continue on certain medications or if they need ongoing nutrition support. It allows patients to have a better quality of life because they can administer these medications/nutrition themselves or through the help of a home health nurse/agency.

Walgreens is one of the few home infusion pharmacies that actually employs RDs. Their DFW office has two RDs on staff, who take care of all the patients this company supports on nutrition support. These patients are receiving ongoing enteral (tube feeds) or parenteral (IV) nutrition ? sometimes for weeks to months, or even up to years to lifelong support. Most of the time, the patients discharge from the hospital with home nutrition support orders. Sometimes the orders may come from an outpatient doctor?s office as well. But regardless, once they are at home these home infusion RDs are responsible for their care.

The job of the home infusion RD is very broad. In some situations, they are the only health care professional who sees this patient for long periods of time. They have to be very proactive and spend a lot of time communicating with doctors about the patient?s status and needs. They really become a patient advocate in many cases.

They will initially provide education to the patients and teach them how to run the nutrition pumps and/or manage their own nutrition support so they can become self sufficient. They will assess the patient over time and adjust their nutrition support if needed. They may advocate for changes to the orders that are originally sent for the patient after their assessment. They check in with patients often and help them manage their home health care. They also travel to patient?s homes and see them in their home environment and help them navigate nutrition support considering in this setting. They will help them to problem solve things like clots in enteral tubes and managing timing of nutrition support with the other priorities in their lives.

While in this rotation, I sat with every member of the home infusion team to understand how everyone works together in a team environment. I saw the intake (new patient) team, the pharmacy techs who compound the IV medications/TPNs, the order specialists who call each enteral patient once a month to obtain their formula and supply orders and the shipment team who take in supplies and then redistribute them in individual packages for each patient.

I obviously also worked with the RDs who taught me about all the pumps and supplies used for nutrition support in the home setting. I received training on how these pumps work and how to teach patients to use them. I also received training from a nurse on all the different forms of IV access into the body and what can be placed in the home by a nurse vs. in the hospital by a doctor.

The best part of the rotation was gowning up and being in the sterile IV compounding room. I worked with a pharmacy tech to make TPNs and other IV medications. It was so awesome to see how TPNs are made and to understand the entire process of how I would write a TPN, to how it gets entered, to how it?s made and then how it?s checked and delivered to the patient?s home.

Home infusion is awesome. These RDs ONLY work with nutrition support and they have a education/counseling component to their job, as well as a business and sales component. I really enjoyed working with these RDs and understanding another area that I could work in one day if I wanted! I definitely will keep home infusion in my mind as a possibility for a combined clinical and business position.

Any questions on home infusion that I can answer? Part 2 will be up in a few days!

Source: http://www.oddduckblog.com/di-home-infusioniv-pharmacymental-healthpt-1/

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