Policy Manual sample

MDT Home Health Care Agency, Inc. FIRST DOSE HOME IV ANTIMICROBIAL ADMINISTRATION PURPOSE: To assess and manage the administration of antimicrobial medications in the home in a safe and effective manner. DEFINITIONS: * Adverse Reaction, often called side effect, is a predictable pharmacological effect that is either drug, non-drug or dose related. * Allergic Reaction is a physiologic response to a specific antigen. * Anaphylaxis is an acute, often fatal systemic reaction resulting from re-injection in a previously sensitized individual. POLICY: * The first dose of any IV medication must be administered under the supervision of a physician. * Where possible the first dose should be administered in the hospital prior to discharge to home health services. * First dose of investigational drugs must be given under the direct supervision of the physician. * Patients receiving drugs that have a high potential for causing anaphylaxis must not be given the first dose in the home, i.e., amphotericin B, chemotherapy agents. * The Registered Nurse assigned to administer IV medications shall be qualified by education and experience and shall have been assessed as being competent by the Agency. * All nurses supervising IV medication infusions in the home must be competent in anaphylaxis management, certified in CPR (preferably ACLS) and proficient in starting peripheral IVs. * Adherence to all other existing candidate selection criteria for home antimicrobial therapy is essential and must include knowledge of patient's complete medical, drug and allergy history, as well as a family allergy history. * If the patient has a history of allergy to the prescription drug, it must be changed to an appropriate alternate to minimize risk of anaphylaxis. Note: Prior exposure may have sensitized the individual; subsequent doses can elicit an allergic response. * A physician's plan of treatment must include an order which states, "first dose of __________________ to be administered in the home", the dose, route, rate of administration, any pretreatment or preinfusion lab work, emergency protocol, specific parameters for adverse drug reaction, postinfusion monitoring and physician's location and phone number during initial infusion. * An anaphylaxis kit must be readily available per a physician's order during the entire infusion. A kit will typically contain, but is not limited to: Adult: • One (1) administration set • Two (2) 21 g butterfly • One (1) 90 mm airway • Two (2) tongue blade (for airway insertion) • One (1) 0.3 mg EpiPen-Injector • Two (2) epinephrine 1:1000 (IM) • One (1) diphenhydramine (Benadryl) 50 mg per mL IV, IM or PO • Six (6) prep pads • Three (3) pairs gloves L-42 Home Health Agency Client Assessments