Patient administration considerations



Patient administration considerations



Learning objectives



1. Discuss patient education for a variety of therapies, common types of intravenous therapy, and delivery of supplies.


2. List several types of infusion pumps, and list some examples of the types of medication therapy in which they are used.


3. List technician responsibilities in infusion therapy in home health care or long-term care.





Introduction


Pharmacy technicians work in a variety of settings, including home health and hospice care. Intravenous (IV) medications are most often prepared in a hospital setting, but they are also prepared in other facilities, such as home health agencies or doctor’s offices, that have USP 797 cleanrooms where technicians prepare IVs for administration either as outpatient or home delivery. It is imperative to follow proper aseptic technique procedures to ensure the most sterile medication possible. In this chapter, we will discuss patient education and rights, common supplies used in home administration, and medication delivery devices or pumps that the technician will be responsible for.



Patient education when administering intravenous therapy in a variety of settings


Patients may receive IV therapy in a variety of settings, including home, hospital, long-term care facilities (e.g., retirement or nursing homes), doctor’s offices, and even as an outpatient. No matter where the therapy takes place, there are always practices that health care workers, including technicians, should take to ensure patient safety and correct administration of medication. Patients should be informed about their therapy and equipment, and they should know what to look for to ensure that the medications are stable and stored properly. Technicians are a valuable part of this team and often are the personnel who maintain the equipment, gather the supplies needed, and prepare the medications for delivery.



Home health care


Patient education is vital in the administration of IV therapy at home, and it should begin before a patient’s discharge from the hospital. Patients should be instructed about the insertion of an IV catheter, peripherally inserted central catheter (PICC) line, or other implantable device that will be used to deliver the infusion. A PICC line can be used to deliver all types of therapy (Figure 10-1). These tiny tubes typically are used for 72 hours since they are inserted in veins close to the surface. Long-term therapy may require weeks, months, or even years, and special catheters designed to be inserted in the chest wall near the heart are used for this. These central venous catheters, such as Broviac and Hickman catheters, have been designed especially for longer duration therapy because they are inserted in larger veins very close to the heart and can stay in place for 1 to 2 weeks. If total parenteral nutrition (TPN) therapy is required, an implantable infusion device, such as a Hickman or Broviac, may be needed. To insert one of these, the surgeon tunnels under the skin into the subclavian vein below the breastbone.


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FIGURE 10-1  A, Peripherally inserted central catheter (PICC line). B, Central line with a Medi-Port. (From Perry AG, Potter PA: Clinical nursing skills and techniques, ed 6, St Louis, 2006, Mosby.)

Patients with peripheral central catheters (PICCs) should be informed about signs of infiltration or phlebitis. This occurs when the solution leaks into the surrounding tissues and causes swelling, redness, and pain. Often the IV site must be rotated to prevent this from happening. Flushing the line should also be done by using the SASH method, which should also be explained to the patient. The SASH method helps the patient remember the steps that need to be followed to flush the IV line. The abbreviation stands for:



Delivery of the supplies for home infusion will include enough heparin and saline to flush the line several times. Flushing the line is necessary after TPN, after intermittent medication infusion, after a blood infusion, and whenever a line needs to be locked. Patients and/or caregivers should also be informed about hygiene and handwashing, setting up the pump with medication, and troubleshooting problems, including 24-hour emergency numbers.


Delivery of all supplies should be timely and complete. Changes in temperature can affect the stability of the sterile preparations.


Refrigerated items should be shipped in coolers, and chemotherapy should be shipped in protective containers. The service should also include pickup of unused and waste items from the patient’s home. Careful planning to include all supplies needed to administer the IV therapy will ensure timely administration without interruption.



imageTECH NOTE!


The technician who is preparing the medication for home delivery needs to know what type of IV line the patient has as well as how the medication is to be delivered, because the supplies to administer this treatment must be assembled and prepared for delivery along with the medication.




Types of intravenous therapy


Chemotherapy infusion can be delivered through the intra-arterial route. The most common routes are the hepatic artery for colorectal cancer; the celiac artery for liver cancer; and the carotid artery for head, neck, and brain tumors. Compact, battery-operated, portable pumps are often used.


Pain management (such as morphine) can be given as a continuous or intermittent infusion. Intermittent dosing or patient-controlled analgesia (PCA) is common for hospice patients and is administered using a pump in which the patient can press a button to receive a dose of narcotics. The pump is preprogrammed in the pharmacy according to the physician’s order and locked so it cannot be changed.


Antiinfectives can also be given at home and should include labs that monitor the patient’s blood level to avoid toxicity. These should be given at specific intervals, are typically mixed as piggybacks, and can be given using computerized ambulatory pumps and syringe pumps.


Antifungals and antivirals may be administered at home using volumetric infusion pumps. These pumps deliver a measured amount and can be programmed accordingly.


Investigational drugs are not approved for general use by the U.S. Food and Drug Administration (FDA). Guidelines, such as eligibility, monitoring for adverse effects, documentation, and disposal, are considerations for the use of these types of medications.

Related posts:

  1. Administration of intravenous products
  2. Chemotherapy nutrition
  3. Quality assurance and medication error prevention
  4. Techniques for preparing intravenous admixtures

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Aug 9, 2016 | Posted by in PHARMACY | Comments Off on Patient administration considerations

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