The Basics of Home Infusion Therapy

1. The Basics of Home Infusion Therapy Presented by: Sina Refahzadeh, PharmD. VP of Specialty Pharmacy Premier Infusion Care January 4th, 2017

2. Outline • Documentation needed to facilitate a home infusion referral • Explaining home infusion benefits to a patient • Elements of a prescription • Types of intravenous access: Peripheral/PICC/Port-a-Cath • Methods of IV administration • IV push, gravity, disposable elastomeric infusion device, electronic pump • Pros and cons of each method • Antibiotics that may safely be administered by IV Push method at home • Common IV policies in Home Health • Oral and Infusion Chemotherapy • Precautions for providing and disposing of bio hazardous chemotherapy materials • 21st Century CURES Act and what this means for home infusion

3. Documentation needed to process a Home Infusion Referral • Patient demographic sheet w/ insurance info, home address, patient contact information, etc • H & P, including height, weight, and dx • IV order, including dose, frequency & duration • Current MAR with dosing times for home medications, including any allergies • Indicate if at-home dose is the first time patient will receive medication (if so, ANA KIT should be included in delivery) • Most recent lab results • Type of IV access: SL or DL PICC, Central, Peripheral or Port • For TPN, current nutrition formula including if TPN is cyclic or continuous, or order stating “TPN per Pharmacy” • SOC date • HH agency assigned to the patient

4. Explanation of Home InfusionBenefits • If possible, benefits should be discussed with the patient or a designated decision maker by a representative from the home infusion provider • Helps ensure that the patient understands the treatment ordered and the insurance coverage breakdown • Assists the infusion company in verifying appropriate insurance and contact information for patient • Patients get their questions answered by a staff member with the company providing the service

5. Elements of a Prescription • Drug + Dose + Frequency + Duration + Prescriber info • IV Vancomycin 1 Gm BID x 6 weeks • QD = ONCE daily • BID= TWICE daily • TID= THREE times daily • QID= FOUR times daily • QOD= EVERY other day • Hardcopy/Fax/Verbal Order • “Per Pharmacy/Pharmacy to Dose” • Drug + Duration + Prescriber • Vancomycin/Gentamicin/TPN

6. Types of Intravenous Access • Peripheral vs Central • Considerations: • Duration + Drug • Peripheral Line • PICC (Peripherally Inserted Central Catheter)/Mid Line • Groshong/Hickman (Adult) / Broviac(peds) • Port-A-Cath

7. Intravenous Administration Methods Complexity • IV Push • Gravity • Mini-Bag Plus • Elastomeric Infusion Device • EasyPump • Electronic Pump • Curlin

8. Intravenous Access • SASH Protocol • Saline • Administration of Drug (Antibiotic) • Saline • Heparin • Peripheral Line vs. PICC vs. PORT • Some brands of central lines are valved, and do not require the use of heparin, e.g., SOLO Power PICC, Groshong Catheter. • When not in use, these need only be flushed with saline once a week

10. Antibiotics that may safely be administered by IV Push method at home(Please consult with pharmacist for each patient, especially if using only a peripheral IV, as not all clinical situations are conducive to IV Push. Some drugs require patient/caregiver mix due to poor stability at these concentrations). • Ampicillin (patient mix-poor stability) • Aztreonam (Azactam) • Cefazolin (Ancef) • Cefepime • Cefotaxime (Claforan) • Ceftazidime (Tazicef, Fortaz) • Cefoxitin • Cefuroxime (Zinacef) • Daptomycin (Cubicin) • Meropenem (Merrem) • Nafcillin • Oxacillin

11. Common IV Policies in Home Health • IV Vancomycin • Peripheral vs. PICC concentration • Labs Required • Order ≥ 7 days, PICC line is preferred • IV Compatibility • Precautionary measures during hospitalization

12. Oral Chemotherapy • Oral chemotherapy medicines are given by mouth in the form of capsules, tablets, or liquid. (PLEASE NOTE: If a patient is on a clinical trial, the physician may give special instructions) • Oral chemo must be stored in its original container. • Most oral chemo is stored at room temperature, away from excess heat and moisture. • The drug should be prepared away from all food and food prep areas and away from other family medications. • Always wash your hands when handling oral chemo and avoid crushed or broken pills. • Any unused oral chemo should be returned to the pharmacy where the prescription was filled. Do not allow patient to flush down the toilet, dump in the sink, or throw away in the trash. • Refer to the Dana-Farber Cancer Institute Website for other helpful tips in managing oral chemo http://www.dana-farber.org/Health-Library/Oral-chemotherapy-fact-sheet.aspx

13. Infusion Chemotherapy • This medication is infused using a pump that ensures the chemo is given at the proper rate and dosage. • Sessions for infusion chemo last between one and several hours and are generally scheduled at one-to-three week intervals. • Other treatment may be included with infusion chemo, such as IV hydration. • A hazardous waste container is included in the supplies for infusion chemo. All needles, IV tubing, chemo bags/cassettes, gloves, gown, syringes, and lancets should be placed in this container once used. • Home RN should use chemo related gown and gloves when administering. • Infusion company should provide a chemo spill kit for accidents

14. 21st Century CURES Act • Providing the NIH with $4.8 billion in new funding for the discovery, development, and delivery of new treatments and cures • Effective January 1, 2017 • For home infusion, part B drug reimbursement was reduced