6.28: Coordination of Home Infusion Therapy with the Home Infusion Provider

6.28: COORDINATION OF HOME INFUSION THERAPY WITH THE HOME INFUSION PROVIDER

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PURPOSE: To ensure appropriate communication between the Agency's nursing staff and the Infusion Company provider regarding the patient’s response to the therapy and the ongoing care needs as it relates to the Plan of Care.

POLICY:

1.  3HC shall provide the Infusion Company relevant information related to the patient's initial and on-going therapy.

2.  The pharmacist shall provide information regarding the drugs and their safe and appropriate use to 3HC staff involved in the patient's care.

3.  For Facility Service Contract patients who are receiving infusion therapy, the paperwork and responsibilities will vary depending upon the contract 3HC has with that particular Infusion Company. (See Appendix A – Staffing Patients Paperwork Guidesheet)

PROCEDURE:

1.  When 3HC accepts a referral for infusion therapy, a copy of the referral is faxed as soon as possible to the Infusion Company Provider.

2.  After the patient is admitted to 3HC, a copy of the Initial Assessment including the Infusion Therapy Service Report and Medication Profile are faxed to the Infusion Company within 48-72 hours of the assessment.

3.  3HC shall notify the Infusion Company as soon as possible if:

a.  There is a change in the medication order.

b.  Patient develops an adverse reaction to the medication.

c.  Patient is admitted to the hospital.

d.  If there is a significant change in the clinical status of the patient.

4.  3HC shall fax the Infusion Company:

a.  A copy of new physician orders.

b.  Updated medication profile when there are changes made.

c.  A copy of all lab results (as soon as possible).

5.  If the nurse from the Infusion Company contacts 3HC with new or changed physician orders, the 3HC nurse can accept these orders, but 3HC will still need a copy of the signed physician’s order when they are obtained by the Infusion Company. If an order from the infusion company is received signed by the pharmacist, the nurse can accept the order, but an interim order must be sent to the physician for signature.

6.  The Infusion Company shall provide the medication, flush solution, infusion pump with pump manual and pump tubing (if applicable) on all the infusion therapy patients. The other infusion therapy supplies will depend upon insurance reimbursement that will be decided at the time of the referral process.

FACILITY SERVICE CONTRACT RESPONSIBILITY: (STAFFING PATIENTS)

A. GENERAL INFORMATION

1.  Review the Clinical Explorer Profile information in McKesson, making updates or additions as necessary. The orders are done in McKesson and 3HC completes the POC. (Refer to procedure 14.45, Entering Staffing Patients in McKesson).

2.  All staffing patients will be under the office/private org level and the Episode Type will be Staffing Services.

3.  3HC required paperwork:

a.  3HC Admission Agreement (paper)

b.  High Risk Consent Form (paper)

c.  SN Comprehensive V3 (initial visit)

d.  Routine V5 Assessment Note (ongoing visits)

e.  Infusion Template (initial and ongoing visits)

f.  Medication Profile (initial visit)

g.  POC (485)

4.  Copies of the following forms shall be faxed to the Infusion Company within 48-72 hours of the initial visit.

a.  SN Comprehensive V3

b.  Medication Profile

c.  Infusion Template

5.  A copy of the following 3HC forms are to be faxed to the Infusion Company within 48-72 hours of the ongoing nursing visits:

a.  Routine (V5) Assessment

b.  Infusion Therapy Service Report

6.  A copy of the medication profile shall be faxed to the Infusion Company when changes are made.

7.  Staffing patients are discharged using the same steps as private insurance patients. (Duke Infusion needs a copy of the Discharge Summary)

8.  3HC shall notify the Infusion Company as soon as possible if:

a.  There is a change in the medication order

b.  Patient develops an adverse reaction to the medication

c.  Patient is admitted to the hospital

d.  If there is a significant change in the clinical status of the patient.

9.  Copies of any physician orders obtained by 3HC are to be faxed to the Infusion Company. If an order from the infusion company is received signed by the pharmacist, the nurse can take the order, but must send a supplemental order to the physician for signature. If the order is signed by the infusion company nurse, a supplemental order does not have to be sent to the physician, but 3HC will still need a copy of the signed physician order when obtained by the infusion company.

10.  All nursing visits have to be pre-approved by the Infusion Company.

11.  When 3HC obtains lab results, they are to be faxed to the Infusion Company as soon as possible. The Infusion Company will fax the lab results to the physician.

12.  3HC shall adhere to the Infusion Company’s protocols in relation to Infusion Therapy. If there is an issue regarding a specific policy/procedure in which the 3HC nurse does not feel comfortable performing the procedure, the nurse shall contact their Clinical Director. If needed, the Clinical Director will consult with the Education Manager, Infusion Pharmacist, and/or Medical Director.

13.  Medications, flushes, supplies and equipment needed for the therapy shall be provided by the Infusion Company. 3HC cannot bill the insurance company for supplies.

14.  3HC is responsible for getting the Infusion Company’s admission paper work completed. The original copy of the completed paperwork is to be placed in the self-addressed, stamped envelope that is in the Admission Packet and mailed to the Infusion Company within 72 hours of the initial visit.

B. VISITING CODES FOR STAFFING PATIENTS

1.  RJ: Open chart

2.  RR: Routine visit up to 2 hours

3.  RK: Hourly code for visits exceeding 2 hours

4.  None of the current contracted infusion providers allow LPNs to make visits on their staffing patients.

Effective Date: May 1992

Review Date: August, 1999, September 2006

Revision Date: July 1993, November 1994, April 1996, July 1997, August 1998, January, 2000, June 2000, January 2002, March 2002, July 2003, October 2007, December 2008, February 2010, August 2011, December 2012

Reviewed by: Sandy Pate RN BSN CRNI®, Education Manager

Approved by:

VP of Clinical Services Date

Staffing Patients Paperwork Guidesheet

Note: Please utilize RNs only on these visits /
Staffing Company / IV Company Paperwork Requirement / 3HC Paperwork Required Initial Visit / 3HC Paperwork Required Subsequent Visits / Comments /
Coram / Complete Coram’s consent form. Send original to Coram in self-addressed, stamped envelope within 48-72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485). Send to MD for signature and forward copy to Coram.
·  Request SN Notes within 7 Days / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  Coram will reimburse 3HC for Vancomycin Peak Visit
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Coram (800) 245-2463.
Accredo / Complete Accredo’s Consent form. Send original to Accredo in self-addressed, stamped envelope within 72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485). Send to MD for signature and forward copy to Accredo. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Accredo (866) 239-6037.
Duke Home Infusion / Complete Duke’s consent form. Fax consent to Duke Home Infusion within 48 hours of admission, along with full assessment, vital signs and SN notes.
Do not use PRN visit note form. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  Do Not Use PRN Visit Form
·  IV Therapy Visit Report
·  POT (485). Send to MD for signature and forward copy to Duke Infusion. / ·  Routine V5 Visit Form
·  Do Not Use PRN Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  Nurse admitting the patient should contact Duke Infusion within 48 hours of the initial visit to verify orders. The name and number of the Duke contact person is on the authorization form.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Duke Infusion (800) 599-9339.
UNC Health Care Specialists / Complete UNC Health Care Specialists’ consent form. Send original to UNC Health Care Specialists in self-addressed, stamped envelope immediately. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485). Send to MD for signature and forward copy to UNC Health Care Specialists. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at UNC Health Care Specialists (800) 239-0462.
·  Nurses should call and speak directly to the pharmacist (919-465-9300) to notify them where the specimen was dropped off. The pharmacist will call and follow-up on the lab results to avoid delays.
Walgreens / Complete Walgreens consent form. Fax to Walgreens within 72 hours of the initial visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to Walgreen’s. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Walgreens (800) 948-6606.
·  Any event not consistent with the routine care or services provided to the patient or related to the safety of the patient shall be reported to the Clinical Coordinator within 24 hours.
·  Walgreens will monitor all lab results.
Curascript / Complete Curascript’s consent form. Fax or mail to Curascript’s corporate office within 48-72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to Curascript. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Curascript (877) 298-6186.
Hemophilia Health Services / Complete Hemophilia Health Services consent form. Fax or mail to Hemophilia Health Services’ corporate office within 48-72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to Hemophilia Health Services. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Hemophilia Health Services. (336-854-3128)
CareMark / Complete CareMark consent form. Fax or mail to CareMark’s corporate office within 48-72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to CareMark. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at CareMark. (800-225-5967)
Advanced Home Care / Complete Advanced Home Care consent form. Fax or mail to Advanced Home Care’s corporate office within 48-72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to Advanced Home Care. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Advanced Home Care. (800-878-8980)
Jabez Infusion / Complete Jabez consent form. Fax or mail to Jabez’s corporate office within 48-72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to Jabez. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Clinical Coordinator at Jabez (800) 432-5114
Liberty Medical Specialists / Complete Liberty’s consent form. Fax or mail to Liberty’s corporate office within 72 hours of visit. / ·  3HC Admission Agreement
·  High Risk Consent
·  Medication Profile
·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  POT (485): Send to MD for signature and forward a copy to Liberty. / ·  Routine V5 Visit Form
·  IV Therapy Visit Report
·  Medication Profile
·  Discharge Summary / ·  Include vital signs on all SN visits.
·  There should not be any change in the POC without first notifying the Crista Clewis Clinical Coordinator at Liberty (910) 625-6665

11/2012

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