Policy Manual sample

MDT Home Health Care Agency, Inc. 49 C) Physician's orders include Anaphylaxis Protocols. D) Patient has no history of allergic reactions to any medications within the same chemical class as the prescribed medication. E) Telephone access is available for emergency assistance. 4) The RN will remain in the home for at least 30 minutes after discontinuing the infusion, or after the administration of an IM, or sub-q injection. NOTE: If the physician will not approve an order for MDT Home Health Care Agency, Inc. anaphylaxis protocol, or provide a reasonable alternative, MDT Home Health Care Agency, Inc. WILL NOT ACCEPT THE PATIENT FOR FIRST DOSE ADMINISTRATION, and the physician shall be informed of this. The director shall be notified prior to contacting the physician. 5) Low dose Amphotericin B may be administered, as first dose in the home, if all other criteria are met. 6) First dose epidural and intrathrecal medications will only be administered if the patient is currently receiving an epidural or intrathecal medication at home and is changed to a medication in the same chemical class. These patients will require review on an individual basis for approval by the physician and pharmacy director. The patient's clinical status, tolerance of previous medication and other changes (i.e., dose increase with first dose medication) will be evaluated. 7) Medications which are excluded from "First Dose" include I-aspariginase, bleomycin, aminophylline and intravenous pentamidine. First dose insulin administration should be evaluated on an individual basis, based on the diagnosis, previous history of hypoglycemic agents, general medical condition of the patient, dose, type of insulin, availability of support systems and allergic history. 8) After an evaluation of the medication and patient's allergies, Director of Certified Operations will make the final determination if the medication is appropriate and safe for “first dose” administration in the home care setting. DOCUMENTATION: Document in the clinical visit note date, time, medication with dosage/volume administered, administration site, appearance of IV site (if applicable), site care (if applicable), patient tolerance of procedure, any adverse reactions, patient/caregiver teaching and response, any physician notification. ____________________________________________________