Receive referral from hospital for drugs & supplies
Inotrope Patient Discharge Planning: Day 1 Pharmacy
Responsibilities Home Health Agency
Responsibilities
Patient meets pharmacy admission
criteria
• Verify central line is/will be placed • Verify point of service delivery location and all
demographic information • Determine who HHA will be billing for nursing
service – the insurance company or pharmacy? • Provide HHA process for paperwork & billing
pharmacy (if applicable). • Determine & confirm who is hooking patient
up to home infusion pump prior to D/C. • Determine & confirm planned date/time of D/C
from hospital • Clarify all communications to assure smooth
transition
Contact HHA & assure
knowledgeable in providing home
inotrope therapy.
Contact D/C planner
Patient meets reimbursement criteria and pharmacy has
required documents of proof
Contact D/C planner
Yes No
Yes
Yes
Confirm that nurse caring for patient is knowledgeable in home inotrope
therapy.
Patient meets reimbursement criteria for home health.
Home health agency (HHA) receives referral from hospital for home health services
Patient meets HH admission
criteria.
Collaborate with pharmacy to provide nurses with educational
materials related to home inotrope therapy.
Contact D/C planner
Contact D/C planner
Yes
Yes
Collaborative Responsibilities
No
• Discuss any questions related to inotrope therapy. • Verify knowledge and answer any questions.
Pharmacy to: • Perform pre-discharge assessment to
assure no additional risk for doing therapy at home
• Contact caregiver and discuss home health care plan and expectations
• Perform pre-admission assessment of home environment for items (phone, electricity, 911 service)
• Call local EMS to inform them of inotrope patient in their area
• Obtain patient specific critical parameters and provide to home health agency along with appropriate standing orders.
• Communicate this information to HHA
Inotrope Patient Discharge Planning : Day 2 Pharmacy
Responsibilities Home Health Agency
Responsibilities
Review with Home Health Agency: • Who contact person is for pharmacy and HHA. • How communication will take place. • Review critical parameters, expected interventions
and physician orders. • Preferred communication with physician with issues re
inotrope therapy specifically • Discuss shared expectations of pharmacy and HHA • Verify if HHA is billing insurance or pharmacy & process
• Verify with D/C Planner who is hooking patient up at hospital and what time med and supplies will arrive there
• Verify caregiver will be available for initial teach /hookup in hospital
• Verify what initial teaching will be done
Collaborative Responsibilities
Communication & Verification
Pharmacy to confirm with D/C planner -current orders & labs: • Patient is stable on dose of inotropes (24 hour minimum) • Fluid and electrolytes are stable • Caregiver will be available for initial teach at hospital • Communicate to HHA
Continue to discharge
Patient & Caregiver: • Perform all activities necessary prior to d/c on inotrope therapy • Instruct on storage/handing of medication & supplies • Provide patient & caregiver with written information & review
emergency plan, HHA contact numbers, etc. • Verify understanding of first home visit date/time • Verify understanding of next scheduled bag change date/time
• Call patient and check on status once home • Verify that remainder of shipment arrived at home and
is stored properly. • Verify home health agency number and planned visit
time • Review emergency plan
Plan delivery of drug & supply & hook-up
Contact cardiologist & D/C planner
Obtain from Pharmacy: • Verification of final orders/critical parameters • Update on patient/caregiver initial teaching and any
concerns • Verify specific hook-up time and next scheduled bag
change • Verify next day HHA admission visit
• Call patient and check on status once home • Verify that remainder of shipment arrived at home
and is stored properly. • Verify nurse’s name & planned visit time • Review emergency plan
Inotrope Patient Discharge Planning : Day 3 Pharmacy
Responsibilities Home Health Agency
Responsibilities
Yes
Await further direction from pharmacy
Yes No
Communication & verification
No
Inotrope Patient Ongoing Care and Collaboration Pharmacy
Responsibilities
Home Health Agency Responsibilities
• Minimum weekly phone call to patient for refill assessment
• Lab results monitoring & analysis • Communicate abnormal lab results
or findings to physician • Inventory monitoring • Preparation and delivery of
medication and supplies • Review and reinforce
patient/caregiver knowledge of critical parameters
• Do not decrease visit frequency until
patient/caregiver independent and knowledgeable regarding critical parameters and reporting
• Minimum weekly visit • Make visits periodically at time of bag change
to observe patient/caregiver compliance with sterile technique and infection control
• Review and monitor compliance with medication regimen.
• Confirm with patient and/or caregiver that they understand critical parameters, reporting, and emergency plan.
• Draw blood specimens & communicate regular location of delivery (to assure pharmacy receives knows where to obtain results).
• Monitor ongoing compliance with proper storage of medications.
• Increase visit frequency when patient symptoms increase or if a change in dosage occurs.
• Identify and communicate areas of concern
• Monitor and verify compliance with medical regimen.
• Communicate any order changes (pharmacy or home health related).