Department Policy Code: D: MM-5675 Fairview .Department Policy Code: D: MM-5675 Entity: Fairview

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Transcript of Department Policy Code: D: MM-5675 Fairview .Department Policy Code: D: MM-5675 Entity: Fairview

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    Department Policy

    Code: D: MM-5675

    Entity: Fairview Pharmacy Services

    Department: Fairview Home Infusion

    Manual: Policy and Procedure Manual

    Category: Home Infusion


    Administration of Medications - FHI

    Purpose: To provide guidelines for safe administration of medications in the

    home environment.

    Policy: I. FHI staff in collaboration determines the appropriate infusion control devices for patient care.

    II. Medications will be administered in the home setting using appropriate equipment and technology to ensure patient

    safety and to facilitate the achievement of desired outcomes.


    Related to Device

    Selection and


    I. The Fairview Home Infusion (FHI) Clinical Safety Committee will approve all infusion control devices used for

    patient care.

    II. FHI clinicians will evaluate and select the appropriate infusion control device for individual patients; options

    include manual, mechanical and electronic devices.

    III. The evaluation should include, but not be limited to:

    A. Patient age and condition B. Prescribed therapy; mechanical or electronic devices

    should be considered for the following :

    1. To provide more accurate infusion rate control than gravity or manual mode.

    2. To initiate and maintain very high or extremely low rates of flow

    3. To give potent drugs at specific and reliable infusion rates

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    C. Patient ease of use

    IV. Electronic Pump Failure Management A. Should equipment fail, FHI will arrange for a pump to be

    delivered to the patients home.

    B. If an equipment failure poses immediate danger to the patient a second pump will be in the home to prevent an

    interruption in medication administration.

    1. Patients receiving continuous inotropes will be sent a back up pump.

    2. Patients receiving other therapies (i.e. pain management), or patients living outside the metro

    area may fall into this category. The need for a

    back up pump will be determined on a case by

    case basis.

    V. Upon initiation of a new therapy, or upon changing therapy, the device to be used will be documented in the medical


    VI. Staff who select, use or teach patients about infusion devices are knowledgeable about the devices being used.

    VII. Manufacturers instructions are followed when using and teaching patients about equipment. Written instructions are

    provided to patients and caregivers.




    I. See Attachment I for preferred administration methods.

    II. Medications are dispensed only after verifying the prescribers order for the medication, the dose, type of access

    device, time and duration of administration. Any dose of a

    medication that falls outside the manufacturers prescribing

    indication, literature citation, or standard of practice in the

    community will be verified with the prescriber for accuracy

    and supporting documentation that will substantiate the dose

    being prescribed. Prior to the dispensing of a medication the

    appropriateness of therapy will be assessed. Refer to the

    following policies for more information:

    A. Patient Care Orders

    B. Drugs Approved for Home Administration

    C. Assessment & Reassessment

    D. Medication Reconciliation

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    III. Prior to the administration of a medication the medication label will be verified by checking the patients name, drug,

    dose, route, solution, time and duration of infusion,

    expiration date. Any questions regarding the accuracy of the

    information on the label will be resolved with the pharmacist

    prior to administration.

    IV. The Infusion pump program must be verified for accuracy prior to dispensing.

    No pump will be reprogrammed in Lock Level 0 by a

    patient or caregiver. (Lock Level 0 permits complete access

    to all programming and other operating features).

    A. All parenteral pumps will be programmed and reviewed by two (2) clinicians after the pump has been locked. Clinicians

    will verify the pump program using the pump programming

    verification record/ Prescription Form printed from CPR+.

    If a second clinician is not available, the same clinician must

    check the pump program twice, with at least 5 minutes time

    elapsing between checks.

    B. Any pump program changes while a pump is in the home must be done by a clinician in the home, and verified by an

    office clinician via telephone. This must be documented in

    the Clinical Record.

    C. If a clinician is not in the home, a newly programmed pump, with pump programming verification record (if sent from

    FHI office), will be sent to the patients home.

    D. Patient/caregiver may titrate pain medication dose in Lock Level 1 (if order/program includes titration) over the phone

    if previously instructed. Refer to Pain Management policy

    V. Visually inspect all medications prior to use. No medication should be given that is cloudy, or contains precipitates. All

    medication shall be used and discarded according to the

    directions on the medication label.

    NOTE: Once opened, multi-dose vials of heparin and saline

    shall be dated, stored in the patients refrigerator, and

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    discarded if not used within 28 days.

    VI. Observe instructions provided by the pharmacy for proper use, storing and handling of drug and solution containers.

    Administer medications at room temperature whenever


    VII. Pediatric patients require special consideration. Refer to policy: Pediatric Home Infusion Therapy

    VIII. Filters of appropriate size will be used as indicated by the patients condition, prescriber order, pharmaceutical practice

    and/ or as recommended by the manufacturer.





    A. Select Necessary Equipment

    1. Prescribed drug or solution

    2. Intravenous administration set, if applicable (with appropriate size filter if indicated by drug therapy)

    3. Alcohol swabs

    4. PPE

    5. Normal saline-filled syringe

    6. Heparin filled syringe, if applicable

    7. Infusion device, if applicable

    B. Administer Medication

    1. Wash hands and don gloves.

    2. Prepare administration supplies aseptically; prime tubing, spike fluid container, etc. as indicated by infusion method

    and by manufacturer directions.

    3. Cleanse catheter end cap with alcohol swab for 15 seconds and allow to air dry completely prior to each


    4. Flush catheter with normal saline to establish patency of the IV access device per protocol. See policy Access

    Device Management, General Policies for flushing


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    5. Cleanse catheter end cap. Aseptically attach administration set or syringe to access device. Regulate

    infusion or activate infusion device to deliver

    medication/solution. Never infuse more than one

    medication or parenteral solution via the same

    administration set.

    6. When infusion has completed, disconnect infusion device/tubing and discard expended supplies in

    appropriate receptacles.

    7. Cleanse catheter end cap. Flush catheter with normal saline and/or heparin per policy.

    8. Remove gloves, dispose in appropriate receptacle and wash hands.


    A. Administration sets shall be changed utilizing aseptic technique immediately upon suspected contamination or

    when the integrity of the product has been compromised.

    B. Intermittent and Cyclic Therapy

    1. Change administration sets with each dose for therapies provided on an intermittent basis (e.g., anti-infective

    therapy) unless otherwise ordered by the physician.

    2. Change administration sets every 24 hours for cyclic TPN and IV hydration administration.

    C. Continuous Therapy

    Change administration sets at the following frequencies for

    therapies provided on a continuous basis, unless otherwise

    ordered by the physician:

    1. Administration sets utilized for TPN and IV hydration every 24 hours.

    2. Administration sets for all other therapies (pain management, inotropes, anti-infective therapy)

    administered via an electronic infusion pump must be

    changed at least every 7 days. Refer to medication label

    for frequency of cassette/bag change; tubing must be

  • Code: D: MM-5675