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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

Subject:

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.

Procedure

Related to Device

Selection and

Management

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 patient‟s 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

record.

VI. Staff who select, use or teach patients about infusion devices

are knowledgeable about the devices being used.

VII. Manufacturer‟s instructions are followed when using and

teaching patients about equipment. Written instructions are

provided to patients and caregivers.

Medication

Related

Procedure:

I. See Attachment I for preferred administration methods.

II. Medications are dispensed only after verifying the

prescriber‟s order for the medication, the dose, type of access

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

medication that falls outside the manufacturer‟s 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

http://intranet.fairview.org/Policies/S_073425

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 patient‟s 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 patient‟s 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 patient‟s 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

possible.

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

patient‟s condition, prescriber order, pharmaceutical practice

and/ or as recommended by the manufacturer.

Administration

Related

Procedure:

I. CONNECTION, PRIMING, DISCONNECTION

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

access.

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

guidelines. http://intranet.fairview.org/Policies/S_074444



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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.

II. ADMINISTRATION SETS

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

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changed at the same frequency.

III. VI. DOCUMENTATION

A. Documentation of medication/solution administration shall

include, but not be limited to:

1. Procedure performed

2. Venous access device

3. Medication/solution, dose, rate, date and time

4. Infusion device type

5. Site inspection

6. Patient tolerance/response

7. Vital signs as indicated

8. Follow-up plan

External Ref: Joint Commission Applicable Standards

Manufacturer‟s guidelines for equipment and supplies

INS Policies and Procedures for Infusion Nursing; 4th Edition, 2011

Pediatric Dosage Handbook 16th

edition ( Taketomo)

Extended Stability for Parenteral Drugs 4th

edition ( Bing)

Trissel‟s – accessed via the internet.

Source: Clinical Managers, Compliance and Education Coordinators

Approved by: FHI Assistant Director; Medical Director

Date Effective: 01/01/1990

Date Revised: 02/14/1991, 03/14/1995, 02/10/1996, 02/29/1996, 04/30/1996,

03/19/1999, 1/1/2001, 10/04/2002, 4/04, 10/05, 10/06, 7/07,

02/2011, 7/2013

Date Reviewed: 7/2013

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(Attachment I)

* Contact Material Supervisor or Pharmacy Manager before accepting

DRUG IVP E E(+) MP G G(+) Pump Pump

(+) Mix IVP

Hep Comp

ABATACEPT (Orencia) P N

ACETADOTE (Acetylcysteine) P Y

ACYCLOVIR P Y

ALGALSIDASE (Elaprase) P N

ALGLUCOSIDASE (Lumizyme) P N

ALTEPLASE (line care treatment) N

AMBISOME P N

AMIKACIN P N

AMPHOTERICIN (Ablecet) P N

AMPHOTERICIN (Ambisone) P N

AMPHOTERICIN (Fungizone) P N

AMPICILLIN X P Y

AMPICILLIN/SULBACTAM X P X Y

ANTICOAGULANT CITRATE P N

AZITHROMYCIN P Y

AZTREONAM P Y

BADD Solution P N

CASPOFUNGIN (Cancidas) P X N

CEFAZOLIN P X Y

CEFEPIME P X Y

CEFOTAXIME P X Y

CEFOXITIN P Y

CEFTAZIDIME P X X Y

CEFTRIAXONE P X Y

CEFUROXIME P Y

CEREZYME (Imiglucerase) P N

CHLORAMPHENICOL P N

CHLORPROMAZINE P N

CIMETIDINE P Y

CIPROFLOXACIN P N

CLINDAMYCIN P Y

CYCLOPHOSPHAMIDE P Y

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(+) Mix IVP

Hep Comp

CYCLOSPORIN A (Sandimmune) P N

CYTOGAM (IVIG) P N

D5/LACTATED RINGERS P N

DACLIZUMAB (Zenepax) P N

DAPTOMYCIN (Cubicin) P X Y

DEFEROXAMINE P N

DEXAMETHASONE P Y

DIAZEPAM ( hospice only ) P N

DIPHENHYDRAMINE P Y

DOBUTAMINE P N

DOLASETRON (Anzemet) P N

DOPAMINE P Y

DOXORUBICIN P Y

ELAPRASE (See Algolsidase) P N

DOXYCYCLINE X P N

ERTAPENEM (Invanz) P X N

FABRAZYME (Agalsidase Bda) P N

FAMOTIDINE P Y

FENTANYL IV, SQ, IT P Y

FILGRASTIM (Neupogen) P N

FLUCONAZOLE (Diflucan) P Y

FLUOROURACIL P X Y

FOSCARNET (Foscavir) P Y

FOSPHENYTOIN (Cerebyx) P N

FUROSEMIDE P Y

GALSULFASE (Naglazyme) P N

GAMMAGARD (IVIG) P Y

GAMUNEX Liquid & SD (IVIG) P Y

GANCICLOVIR (Cytovene) P X N

GENTAMICIN P N

GRANISETRON HCI (Kytril) P N

HALOPERIDOL LACTATE P N

HYDROMORPHONE IV,SQ P N

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(+) Mix IVP

Hep Comp

IBANDRONATE (Boniva) P Y

IDURSULFASE (Elaprase) P N

IFEX/MESNA P Y

IMIGLUCERASE (Cerezyme) P N

IMIPENEM/CILASTATIN (Primaxin) X P N

IMMUNE GLOBULIN 6% SEE IVIG P N

INFLIXIMAB (Remicade) P N

IRON SUCROSE- See venofer N

IVIG - see brand N

KETAMINE HCl P N

KETOROLAC P N

LACTATED RINGERS P X N

LEVETIRACETAM (Keppra) P N

LEVOFLOXACIN (Levaquin) P N

LINEZOLID (Zyvox) P Y

LORAZEPAM P Y

LUMIZYME See Alglucosidase P N

MAGNESIUM SULFATE P X Y

MEROPENEM (Merrem) X X P Y

MESNA P N

METHYLPREDNISOLONE (Solu-Medrol) X P Y

METOCLOPRAMIDE P Y

METRONIDAZOLE 500mg P Y

MICAFUNGIN P N

MILRINONE (Primacor) P Y

MORPHINE SQ IV P Y

NAFCILLIN X P Y

NAGLAZYME (Galsulfase) P N

NATALIZUMAB (Tysarbi) X P N

OCTAGAM (IVIG) P Y

ONDANSETRON P X X Y

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(+) Mix IVP

Hep Comp

OXACILLIN P Y

PALONOSETRON (Aloxi) P N

PANTOPRAZOLE (Protonix) P N

PENICILLIN G K P Y

PENICILLIN G Na P Y

PHENOBARBITAL ( hospice only) P N

PIPERACILLIN P Y

PIPERACILLIN/TAZOBACTAM (Zosyn) P X Y

PRIVIGEN (IVIG) P Y

PROCHLORPERAZINE P Y

PROMETHAZINE (only method) P N

RANITIDINE P Y

SMX/TMP(BACTRIM) P N

TICARCILLIN/CLAVULANATE (Timentin) P X Y

TIGECYCLINE P N

TOBRAMYCIN P X Y

TORSEMIDE P N

VALPROATE (Depacon) P N

VANCOMYCIN P X N

VELAGLUCERASE ALFA (VPRIV) P N

VENOFER ( iron sucose) P N

VIVAGLOBIN (SQ+B) (SubQ) P N

VORICONAZOLE (VFEND) P N

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Key: IVP-Intravenous Push E-Elastomeric Ball E (+)- Elastomeric Ball plus patient adds drug MP-Minibag plus G-Gravity Bag G (+)- Gravity Bag plus patient adds drug Pump-Electronic Pump (+)- Patient adds to bag with pump Mix IVP-Patient reconstitutes/draws up P-Preferred

X-Alternative method

Heparin compatibility - reference is ESPD 4th ed 12/30/2010 ddd/kb

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(ATTACHMENT II)

FILTRATION SUMMARY

This is not an all-inclusive list. See manufacturer’s recommendation for filters based on specific drug.

5 micron filter needle 1.2 micron air eliminating

filter

0.22 micron air

eliminating filter

Preparing medication

from glass ampules X

Patients taught to

reconstitute medications

in the home for IV push

administration

X

TPN (3 in 1, dextrose

amino acids with lipids)

X

TPN (2 in 1, dextrose

amino acids without

lipids) *

X

Intraspinal infusions X

Nafcillin via electronic

infusion device

X

Chemo therapy via

electronic infusion device

X

Gravity infusions via mini

bag plus

X