Home Care Pharmacy Research Articles

Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P < .001) and may be attributed to a shift in the patient population, with more patients having malabsorption as the indication for therapy in 2010 ( P = .003). There were more than twice as many episodes of dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

Risk Factors for the Development of Catheter‐Related Bloodstream Infections in Patients Receiving Home Parenteral Nutrition

Risk factors for development of catheter-related bloodstream infections (CRBSI) were studied in 125 adults and 18 children who received home parenteral nutrition (HPN). Medical records from a national home care pharmacy were reviewed for all patients that had HPN infused at least twice weekly for a minimum of two years from January 1, 2006-December 31, 2011. Infection and risk factor data were collected during this time period on all patients although those patients who received HPN for a longer period had data collected since initiation of HPN. In adults, 331 central venous catheters (CVCs) were placed. Total catheter years were 1157. Median CVC dwell time was 730 days. In children, there were 53 CVCs placed. Total catheter years were 113.1. Median CVC dwell time was 515 days. There were 147 CRBSIs (0.13/catheter year;0.35/1000 catheter days). In children there were 33 CRBSIs (0.29/catheter year;0.80/1000 days; P < .001 versus adults). In adults, univariate analysis showed use of subcutaneous infusion ports instead of tunneled catheters (P = .001), multiple lumen catheters (P = .001), increased frequency of lipid emulsion infusion (P = .001), obtaining blood from the CVC (P < 0.001), and infusion of non-PN medications via the CVC (P < .001) were significant risk factors for CRBSI. Increased PN frequency was associated with increased risk of CRBSI (P = .001) in children, but not in adults. Catheter disinfection with povidone-iodine was more effective than isopropyl alcohol alone. There were insufficient patients to evaluate chlorhexidine-containing regimens. Numerous risk factors for CRBSI were identified for which simple and current countermeasures already exist.

Experiential Learning of Systems-Based Practice: A Hands-on Experience for First-Year Medical Residents

Systems-based practice, a domain of expertise mandated for all residencies by the Accreditation Council for Graduate Medical Education, requires an interdisciplinary approach that involves communicating with the other members of the health care team as well as utilizing the many components of health care delivery. The Mercy Catholic Medical Center internal medicine residency leadership developed a two-week supervised experience in systems-based practice for first-year medical residents to give them firsthand experience with nonphysician providers' delivery of health care. The disciplines in the experience were home care services, hospice care, pharmacy services, laboratory services, utilization services, and nutrition services. Nonphysician health care providers willingly made themselves available for this educational activity because they felt that such face-to-face interaction fosters an improved understanding of their discipline and its services in the participating physicians. Surveys of resident knowledge pre- and postworkshop suggested that the residents' rudimentary understanding of these disciplines developed into both a deeper theoretical understanding and a greater knowledge of specific policies regarding these health care services. This type of experience is likely a necessary first step toward developing physicians who can provide interdisciplinary medical care that integrates the many other health care disciplines into a comprehensive plan to maximize health outcomes. As physicians become leaders of multidisciplinary teams in the 21st century, firsthand knowledge of the other health services enhances their capacity to maximize the services of these other disciplines for the benefit of patient care.

Pharmacists and Home Care: The Agency Perspective

Early in its development, home care pharmacy focused on the provision and monitoring of intravenous medications. 1 – 3 Its role has expanded to include patient and health professional teaching, drug utilization reviews, and contributions to program and policy development. 3 , 4 There are few rigorous studies of the impact of home care pharmacy services, but existing studies do show that these services result in improved patient care and patient outcomes. 5 – 7 Consequently, the potential for pharmacists to play a needed role in home care provision, and communicate that value, is of interest to many health organizations.

Central Line-Associated Bloodstream Infection Surveillance and Reduction Strategies across the Continuum of Care of a Tertiary-Care Pediatric Institution

BACKGROUND: Central line–associated bloodstream infections (CBSIs) are the most common type of device-related, healthcare-associated infection across the care continuum at Columbus Children's Hospital (CCH). CBSIs result in prolongation of hospitalization, morbidity, and mortality at CCH and nationally. OBJECTIVE: To demonstrate the value of CBSI surveillance across the care continuum and of interdisciplinary collaboration to identify and implement interventions to reduce the risk of occurrence. METHODS: In 1990, CCH became a member of the Centers for Disease Control and Prevention's (CDC) National Nosocomial Infection Surveillance System (NNIS). Surveillance began in the pediatric intensive care unit (PICU) and the neonatal intensive care unit (NICU). The other inpatient units and Home Parenteral Nutritional (HPN) Program were added in 1994, followed by CCH's Homecare (HC) in 2000. Infection control practitioners (ICPs) conduct surveillance in all inpatient units utilizing NNIS criteria. Nutritional Support Services collects HPN data; HC collects data based upon Infection Control Committee (ICC)–approved criteria. Epidemiology assists with interpretation, analysis, and recommendations for these areas. Meetings occur regularly to identify opportunities for improvement and to ensure consistent practice in all settings. RESULTS: Rates are expressed as the number of CBSI/1000 central line days. The following are a comparison of rates from 2000 and 2003 year to day by site or service: Hospital-wide (6.5 versus 4.9, p = 0.015); PICU (7.8 versus 5.5, p = 0.150); NICU (10.5 versus 6.3, p = 0.006); HC Private Duty Nursing (4.0 versus 1.9, p = 0.273); HC Pharmacy Only (2.0 versus 1.7, p = 0.360); HPN patients served by CCH HC (9.0 versus 5.6, p = 0.093), and those served by other HCs (3.8 to 8.0, p = 0.178). CONCLUSIONS: 1) CBSI surveillance across the care continuum is essential. 2) Interdisciplinary collaboration maximizes identification of opportunities to improve. 3) Direct observation of healthcare workers' practice with feedback and standardized policy/practice is essential. 4) Feedback to other HC companies caring for our patients is necessary. 5) Administrative, Medical Staff, and ICC support is critical. 6) An organizational culture of patient safety is required. 7) In 2003, an IV Access Taskforce identified interventions including a budget-approved IV Access Team.

Benefits of residency training programs in home care pharmacy practice.

Benefits of residency training programs in home care pharmacy practice.

Home care pharmacy: extending clinical pharmacy services beyond infusion therapy.

A clinical pharmacy program was developed at an established home health care (HHC) agency to demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies. Initial experiences of this pilot project are described. Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred to the agency required infusion therapy, multiple opportunities for pharmacist involvement in patient care were identified and a variety of projects were undertaken. A drug information service was developed, a retrospective evaluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitoring was assessed, pharmaceutical care services were provided to patients enrolled in a long-term home care program, a pain management initiative was begun, adverse drug reactions were identified and reported, and pharmacists participated in agency policy development. Preliminary data suggest that pharmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recommendations of which 33% were accepted. Pharmacists working with a home care agency identified numerous opportunities for improving patient care. Many of the patients receiving home care services were elderly, took a substantial number of medications, and were at risk for drug-related problems and suboptimal therapy.

Task analysis of home care pharmacy.

The demographics of home care pharmacists and the frequency and perceived importance of home care pharmacy tasks were studied. Two questionnaires were mailed in August 1994 to each of 1420 sites that provide home care pharmacy services. Home care pharmacists were asked to provide information on themselves and their companies and to rate 47 home care pharmacy tasks (administrative, clinical, distributive, and miscellaneous) on how often they are performed as part of the job and how essential they are for successful job performance. Of the 2840 surveys mailed to the 1420 sites, questionnaires for 87 sites were not deliverable, leaving an adjusted gross sample of 1333 sites. A total of 393 usable questionnaires were received from 326 sites (net site response rate 24.5%). Respondents tended to be male, have a B.S. degree only, and have more than six years' home care experience. The most commonly identified type of employer was an independent company. Some 34% of respondents said their company had only 1 site; another 33% stated more than 50 sites. Forty-three percent of locations had 2 pharmacist full-time equivalents. Distributive tasks had the highest frequency scores; clinical tasks were performed second most frequently. Distributive and clinical tasks also received high importance scores. The data suggests that, despite other demands on their time, home care pharmacists give considerable attention to tasks consistent with pharmaceutical care. A survey of home care pharmacists provided baseline information on demographics and the frequency and perceived importance of specific tasks.

Determining eligibility for accreditation of home pharmaceutical services

Many misperceptions exist in the health care community about the Joint Commission's accreditation of home pharmaceutical services, primarily related to when pharmacy services are considered home care and which patients or services are eligible for survey. This article concentrates on eligibility for survey and accreditation of just one of the sixth eligible home caer services—home pharmaceutical services. The concept of home caer and pharmaceutical services is difficult for most people to understand. Unlike other home care services, pharmacy services cannot be provided directly in the patient's home. Pharmacy laws prohibit pharmacists from compounding and dispensingn directly in the patient's home. The pharmacists must do these activities in a licensed pharmacy. Also, most patients who receive medications from pharmacies take their own medications in their homes. So the differences between home care pharmacy and ambulatory or retail pharmacy are much less clear-cut than the deliver of more traditional home care services such as nursing or home health aide services.

Pediatric home infusion therapy: Obstacles and opportunities

Hospitalization is a stress-provoking and disruptive event for a child and family and can create a financial burden for the parent, caregiver, and health care system. In recognition of these issues, a trend toward moving "high-tech" care from the acute care setting has resulted in greater opportu nity to provide home infusion therapy for children. This article discusses the experience of the Texas Children's Hospital Home Care Pharmacy program and describes ways in which an agency can address the many obstacles associated with care of the pediatric patient referred for home infusion therapy.

Ambulatory antibiotic infusion devices: Extending the spectrum of outpatient therapies

study objective: To examine the safety and efficacy, as well as the economic impact, of outpatient intravenous antibiotic administration using an ambulatory infusion pump. design: Retrospective analysis of patients treated through a single home care pharmacy. setting: General community and skilled nursing facilities of the greater Monterey (California) area. patients: Ninety-eight consecutive patients with infections requiring parenteral antibiotics, treated outside the acute-care setting and not eligible for traditional intravenous minibag administration. interventions: Patients received intravenous antibiotics either in the home setting (86%) or in skilled nursing facilities (11%) using a Pharmacia Deltec CADD-VT ambulatory infusion device. measurements and main results: Between April 1, 1986, and July 30, 1988, 98 patients received parenteral antibiotics using an infusion pump, and complete data were available on 96 (98%). A total of 109 treatment courses were given over 1,917 treatment days, with a mean duration of therapy of 18 days. Twenty-three different infections were treated by the use of 12 separate antibiotics. The most common complications included vein irritation (11%) and the inability to maintain venous access (6.2%). Therapy costs were equivalent to or less than the intravenous minibag system depending on the frequency of antibiotic administration. Eighty percent of patients experienced successful resolution of their infection. conclusions: Ambulatory antibiotic infusion pumps can be used safely and effectively in the outpatient setting. Use of these pumps should increase the number of patients eligible for out-ofhospital treatment, resulting in a marked reduction in treatment costs.

Environmental protection efforts by a home-care pharmacy

Journal Article Environmental protection efforts by a home-care pharmacy Get access Paula M. Brown-Soo Paula M. Brown-Soo Clinical Pharmacist New England Critical Care, 10168 L Street, Omaha, NE 68127 Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 48, Issue 1, 1 January 1991, Pages 118–119, https://doi.org/10.1093/ajhp/48.1.118 Published: 01 January 1991