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Home infusion pharmacy

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pharmacy that prepares and dispenses infusion therapies to patients in the home and alternate sites

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Can be found:

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in a variety of settings, ranging form community pharmacies, long-term care pharmacies, and hospital pharmacies to regional or national home infusion companies

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Types of Infusion Therapies

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Anti-infective therapy Antifungal therapy Pain management therapy Chemotherapy Nutrition therapy Hydration therapy Biotechnology therapy Miscellaneous therapies Ancillary drugs

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Anti-Infective Therapy

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Most common therapy Antibiotics, antifungals, and antivirals Used to treat infections that require long-term IV therapy

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Antifungal Therapy

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Therapy used to treat pesistent or serious fungal infections that are not responsive to oral therapy

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Pain Management Therapy

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Involves continuous intravenous, subcutaneous, or epidural infusion of controlled substance analgesics to provide relief from chronic pain

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Chemotherapy

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Home chemotherapy involves antineoplastic drugs that need to be infused over several days

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Nutrition Therapy Two types used

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enteral therapy parental nutrition

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enteral therapy

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infused into GI tract by means of a tube

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parenteral nutrition therapy

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infused into the patient through a vein

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hydration therapy

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intravenous replacement of fluids, electrolytes, and vitamins lost as a result of dehydration

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Biotechnology therapy

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administered for various conditions usually given over long periods of time and are therefore ideal for administration in the home setting

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miscellaneous therapies

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intravenous infusion, subcutaneous, or conventional IV injection

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ancillary drugs

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injectable drugs to assist in therapy flush IV catheters to prevent occlusion (blockage)

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elements of home infusion pharmacy

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personnel inventory pharmacy design equipment and supplies delivery service

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personnel

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pharmacists (home infusion therapist) pharmacy technicians drivers support personnel

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inventory

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limited and specialized does not include oral dosage forms of medication injectable drugs, intravenous fluids, ancillary drugs

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pharmacy design

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resembles the design of the sterile products preparation area of a traditional hospital pharmacy IV compounding area is a "clean room" for the preparation of sterile products Secure area for the storage of drugs and IV compounding supplies

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equipment and supplies

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similar to traditional hospital pharmacy specialized computer software capable of prescription processing, inventory management, clinical record keeping, and billing

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delivery systems

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timely delivery is critical to avoid interruption of therapy and to guarantee integrity of sterile products changes in temperature can affect stability of sterile products

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Home Infusion Therapy Process

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Pharmacy patient assessment Pharmaceutical care plan Monitoring Dischare assessment Documentation

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Pharmacy Patient Assessment

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completed by the home infusion pharmacist upon admission to home infusion service basis for clinical decisions by the pharmacist includes patient demographic information, primary diagnosis, medical history, functional limitations, inital laboratory work, and review of body systems includes nutrional assessment and drug regimen review

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Pharmaceutical Care Plan

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drug-related problems of care

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Who develops the pharmaceutical care plan?

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the pharmacist at start of therapy

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What is the purpose of the pharmaceutical care plan?

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to achieve goals of drug therapy and to minimize drug-related problems

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Five elements of pharmaceutical care plan

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problems goals interventions monitoring resolution

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problems

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including problems being treated with medications

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goals

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desired therapeutic outcomes

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interventions

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pharmacy-related activities that can achieve desired goals

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monitoring

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information that can indicate if interventions produced desired goals

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resolution

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documentation that the problem has been resolved

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Vascular Access Devices

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access to the bloodstream

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Vascular Access Devices depends on:

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age and mobility of patient, condition of patient's veins, type and volume of therapy to be infused, and length of IV therapy

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Two types of vascular access

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peripheral vascular access central vascular access

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peripheral vascular access

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access to the bloodstream through a peripheral vein

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central vascular access

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used for long-term IV therapy or for drugs that are irritating to the vein by using a vascualr access device

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vascular access devices

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peripheral catheters midline catheters central venous catheters peripherally inserted central venous catheters subcutaneous ports

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peripheral catheters

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peripheral line short, flexible intravenous catheter that is inserted into peripheral vein in the arm used for short-term therapy, generally less than 10 days

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midline catheter

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long, flexible intravenous catheter that is inserted into a peripheral vein in the arm and threaded approximately 6 inches up the arm can be left in place for up to 4 weeks used for IV medication that is irritating to the vein

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central venous catheters

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rigid intravenous catheter that is surgically inserted into a large vein in the chest tip is positioned in superior vena cava can remain in place for months, up to a year used for IV therapy that required large volume of fluid or for very irritating IV therapy

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Peripherally Inserted Central Venous Catheter

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PICC line flexible, intravenous catheter that is inserted peripherally into a vein in the arm and threaded into a large vein in the chest X-ray required to verify placement can remain in place fro months, up to a year

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subcutaneous ports

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vascular access device that is surgically implanted into a large vein in the chest all parts of the device are under the skin consists of a reservoir covered by a rubber diaphragm and an attached catheter huber needle accesses the port through the skin

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infusion devices

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regulates the infusion of an intravenous therapy regulates the flow of medication into the patient referred to as infusion pumps: stationary infusion pump ambulatory infusion pump

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stationary infusion pump

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attaches to IV pole

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ambulatory infusion pump

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small, lightweight, and portable so it can be worn

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delivery systems for infusion therapies

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gravity infusion system syring infusion system

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gravity infusion system

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contains medication in minibag and is infused by gravity is regulated by controlling the number of drops

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syringe infusion system

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medication is contained in the syringe is infused through special syring pump

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delivery systems for infusion therapies

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elastometric balloon system IV push system

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elastometric balloon system

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drug contained inside pressurized balloon reservoir and infused by deflating the device rate of infusion is controlled by special tubing

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IV push system

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drug in syring is infused by manually depressing plunger of the syringe infused rapidely

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Home Infusion Supplies

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IV start kits Antibacterial cleaning solutions CVC dressing kit Sharps containers IV tubing Tape Extension tubing Masks IV clave Gloves IV filters Batteries IV poles Chemotherapy spill kits Sterile dressings Ancillary drugs Needle-less syring systems Infectious waste bags and recepticals Injection caps

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Types of Enteral Feeding Tubes

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nasogastric tube nasoduodenal tube nasojejunal tube percutaneous endoscopic gastrostomy tube percutaneous endoscopic jejunostomy tube

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Enteral Nutrition Therapy

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access to gastointestinal tract enteral formulas enteral infusion equipment and supplies

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Legislation and Regulations for Home Infusion Pharmacy

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Medicare Part D Omnibus Budget Reconciliation Act of 1990 Drug enforcement agency regulations FDA Safe Medical Devices Act USP Chapter FDA Alumninum Mandate NIOSH Freedom of Choice Law JCAHO Standards for Home Infusion Pharmacy

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Medicare Prescription Drug Benefit

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Medicare Part D Cost of delivery is incorporated into a higher dispensing fee for home infusion pharmacy Pharmacy, nursing services, supplies, or equipment is not covered by Medicare Part D

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Omnibus Budget Reconcilitaion Act of 1990

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OBRA 90 Mandates patient counseling Home infusion pharmacist required to counsel home infusion patient about safe and effective use of infusion drug therapy Phone consultation, home visit, or through written or printed information

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Drug Enforcement Agency Regulations

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not necessary for original written prescription to be delivered to the home infusion pharmacy copy of prescription may be faxed to home infusion pharmacy home infusion pharmacy must retain copy of prescription

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FDA Safe Medical Devices Act

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requires that all medical devices be tracked infusion pumps, IV

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United States Pharmacopeia (USP) Chapter

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pharmaceutical compounding sterile preparations published in 2003 and put effect in 2004 sets standards on compounding, preparation, and labeling of sterile drugs to ensure accuracty and sterility of compounded sterile drugs

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FDA Aluminum Mandate

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Food and Drug Administration mandated new requirements for TPN formulations in regard to aluminum content in 2004 Aluminum content of products used to compound TPN solutions labeled by the maufacturer

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NIOSH's Hazardous Drug Alert

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National Institute for Occupational Safety and Health (NIOSH) issued and alert in 2004 that set guidelines for preparation of chemotherapy of other cytotoxic agents Drugs can be hazardous to the handler's health

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Freedom of Choice Law

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Allows patients to select the pharmacy of their choice for services, including home infusion services

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JCAHO Standards for Home Infusion Pharmacy

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Joint Commission on Accreditation of Healthcare Organizations the primary accrediting organization for home infusion therapy surveys the home infusion pharmacy for compliance with USP Chapter regulations for sterile compounding

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Two other accrediting organization

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Community Health Accreditation Program (CHAP) Accreditation Commission Health Care (ACHC)

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Role of the Pharmacist in Home Infusion

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Clinical role Dispensing role Administrative role

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Clinical Role

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Indentifying problems Assessing patients Developing care plans Performing interventions Monitoring therapy Collaborating with health care team

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Clinincal Role

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Nutrition support Detecting adverse drug interactions Participating in patient care conferences Documenting clinical studies Providing drug information to health care team Counseling patients and caregivers

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Dispensing Role

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Compounding home infusion therapies and providing equipment and supplies: - Screening prescription orders - Compounding calculations - Compounding or supervising compounding - Determing appropriate infusion device - Selecting necessary supplies - Performing final check on medications, equipment, and supplies

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Administrative Role

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Management of home infusion pharmacy: - hiring, training, and testing pharmacists and pharmacy technicians - supervising all pesonnel - developing policies and procedures - ensuring compliance with state and federal legislation and regulations - purchasing drugs, equipment, and supplies - maintaining records

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Role of the Pharmacy Technician in Home Infusions

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Must possess knowledge of: - compounding sterile products - home infusion therapies and nutritional products - home infusion process - aseptic technique - pharmaceutical calculations

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Role of Pharmacy Technician in Home Infusions

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Must posses knowledge of: - vascular access devices - home infusion equipment and supplies - documenting and record-keeping requirements - reimbursement - computer skills - legislation and regulations pertaining to home infusion pharmacy

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Role of the Pharmacy Technician in Home Infusions

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Sterile compounding Equipment and supplies Computer functions

Chapter 7: Home Infusion Pharmacy – Flashcards

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