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What it takes to start an infusion therapy program.

In an odd sort of progression, a new technology that took root in the home care of elderly patients is now spreading to the nursing home:

Infusion therapy for hydration, nutrition and pain management. This is now a very real - and reimbursable - possibility for nursing homes that are ready and able to try it. As with any move into sub-acute care, though, incorporating infusion therapy takes some careful thought and planning. In a recent interview with NURSING HOMES Editor Richard L. Peck, Debbie Gonzalez, Director of Clinical Services for InfuTech (an Englewood Cliff, NJ firm that installs and trains staff in infusion therapy, and manages several nursing homes as well), commented on factors needing consideration by administrators and DONs interested in adopting this approach:

Peck: What are some initial considerations in moving toward infusion therapy in the nursing home?

Gonzalez: The basic ones, of course, are the qualifications of the staff and the number of residents who would need to be serviced by that staff. If you have one RN and the residents are scattered over two or three floors, this may not work very well. As for staff qualifications, you should consider at the outset whether your state restricts such activity to RNs only or whether LPNs can have a role. In New York State, for example, trained LPNs can put in IV needles, but they are not allowed to perform total parenteral nutrition (TPN).

Peck: What sort of staff training is required and available?

Gonzalez: Basically, this is a matter of selected staffers acquiring proficiency in IV administration. For example, we offer a course of 10-12 hours combining didactic education on geriatric anatomy and physiology - the importance of electrolyte balance, for example - with hands-on training in putting in IVs.

Of course, there are those facilities that just don't feel ready to get started with this.

Peck: What are their reservations about it?

Gonzalez: For one thing, there's the increased clinical responsibility that is involved. For another, if LPNs are not allowed a role in this, then this means hiring more RNs, and that's expensive. On the other hand, this can be a way of keeping RNs already on the staff stimulated and involved.

Peck: As a practical matter, what staff-to-resident ratio is necessary for proper implementation?

Gonzalez: In most facilities it is one nurse to every three-to-five residents. That may change as nursing facilities get more comfortable with this.

Peck: What would some of the principal uses be of infusion therapy in the nursing home?

Gonzalez: Hydration is a very important role. You can observe the patient's fluid and electrolyte status and intervene, if necessary, before a hospital admission is required. This is important, of course, in warding off serious infections, such as pneumonia. Importantly, this is reimbursable under Medicare Part B. So, too, is another use of infusion therapy in the nursing home, pain management.

On the other hand, infection control with IV antibiotics - another established role for infusion therapy - has not been Medicare-reimbursable since Medicare catastrophic coverage was repealed a couple of years ago, and this is obviously an important factor in its adaptability to nursing home care. We are urging legislative change along these lines because this is a major expense - a day's worth of a third-generation cephalosporin can wipe out a nursing home's per diem, and nursing homes just don't have the money for this.

Peck: What do you see as the outlook for infusion therapy in the nursing home?

Gonzalez. I think nursing homes are going to feel compelled to move in this direction in the '90s. Infusion therapy can be cost-saving by reducing the need for hospitalization. On the other hand, it enables hospitals to discharge elderly patients, who have no care provider at home, safely and responsibly to a nursing home. Case managers are very excited about this possibility, and this in turn offers a marketing opportunity to the nursing home. Case managers these days are actively seeking nursing homes that can provide infusion therapy services.
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Title Annotation:interview with Debbie Gonzales
Author:Peck, Richard L.
Publication:Nursing Homes
Article Type:Interview
Date:Aug 1, 1992
Words:665
Previous Article:Surviving with the ADA: hiring staff.
Next Article:Infusion technologies of the '90s.
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