There are many learning curves depending on your “branch” of pharmacy. Home infusion is an often-overlooked area that is a hybrid between a clinical-focused career and a retail career. There is collaboration with physicians, nurses, and patients. In conjunction with physicians, we safeguard antibiotic dosing and microbial coverage. Working with nurses ensures timely labs and proper supplies for site care. Patients, over time, have come to trust pharmacists as an accessible source of information and may have questions we are best equipped to answer. There will also be medication and supply deliveries to coordinate. Providing weekly check-ins with patients provides pharmacists an opportunity to assess medication tolerability and minimal side effects. You may not know what to brush up on before moving into home infusion, so here are a few suggestions.
Pharmacists may provide patients an education upon initiation of services. Patients need to know what to expect from their line, line care, labs, and the medication itself. How should they shower with their line? If they are connected to a pump, how should they shower to keep the pump dry? Which side effects are normal from their medication and which should they watch out for? If their pump malfunctions or they cannot infuse their dose, what should they try and who should they call?
There are specific supplies are needed for each type. Different medications are infused through specific line types.Understanding how lines are maintained and care for, the context of the line in overall care, is imperative. There are PICClines, peripherally inserted central catheter, which go in through the hand or elbow area and are threaded up to the big vein right before the heart atrium. They can be single, double, or triple lumen. A midline is inserted in the same location but only goes up to around the armpit. A Hickman catheter is similar but inserted by the clavicle with the catheter tip before the atrium. Port-a-cath is preferred for chemotherapy and can be maintained for much longer. Occasionally hospice patients will have subcutaneous lines for pain pump administration. Some may even have peripheral lines. Line type can depend on expected duration of therapy.
As pharmacists this is a given but for home infusion the key is knowing with which medications to be familiar. Antibiotics may include cefazolin, ceftriaxone, ceftaroline, daptomycin, vancomycin, ertapenem, meropenem, amikacin, gentamicin, and more. You will want to become familiar with normal dosing (dosages and frequencies), expected or concerning side effects, labs needed, and counseling points for patients. Besides antibiotics there will also be TPNs, total parenteral nutrition, hydration therapy, chemotherapy, and/or pain pumps. This may vary depending on your company, health system, and patient population.
It may surprise you (or not) to learn there are different ways and types of infusing medications. Some are given IV push, 10-20ml in a syringe, like cefazolin and ceftriaxone. Vancomycin is given over 90 minutes to two hours typically and can be given through an elastomeric infusor ball. Pain pumps are given both continuously and via patient-administered boluses. This requires a 24-hour pump. Selecting the appropriate infusor type is a learning curve with considerations include therapy type, stability alterations, insurance coverage, patient ability to administer, and anticipated duration of therapy. Furthermore, each infusor type requires different supplies. This is part of the “context” of the line referred to previously.
Home infusion is a subcategory of pharmacy you may or may not have considered before. Generally speaking, pharmacists like to be prepared. Brushing up on these things will promote success as you begin your home infusion career.