Being a home infusion pharmacist is a great job. It surprises me that there are many pharmacists out there who have no idea what a home infusion pharmacist does (or even what home infusion is) and how the job crosses over to many other pharmacy jobs. Home infusion patients come from many sources including patients discharged from a hospital or other institution. directly from the emergency room, from a physician office, from an insurance company or sometimes it is a self referral.
Inpatient pharmacists are rarely involved in the discharge process when home infusion is involved. The inpatient pharmacist can be a great addition to the discharge process. When patients go home the choice of medication and the route and frequency can be the difference between compliance and non-compliance with patients. Planning ahead helps. Having a patient on a q12h antibiotic that is administered at 3am and 3pm in the hospital just does not work when going home. Changing that schedule prior to a patient's release can be very beneficial to compliance. When a patient is discharged on this type of schedule often results in a missed dose. Contrary to the idea that a nurse infuses every dose in the home, patients/caregivers are taught to do the infusions. Teaching at patient for a 3am dose just is not acceptable. If the schedule can be changed in the hospital a couple of days prior to discharge would certainly help. Almost certainly that 3 am dose is not going to be given. For some medications changing that first dose from 3 am to 10am is not going to be an issue but for medications like Vancomycin that could affect a patient. Dose frequencies can also be problematic. While a q16h or q18 hour Vancomycin in the hospital is not an issue it is a real problem in the home. While it is confusing for patients, nursing visits for lab draws become a nightmare. Nurses need to draw labs prior to a dose of Vancomycin. They certainly can't plan their visits for those dose times and lab draws are not very accurate.
Another issue can be the selection of an antibiotic. When choosing a medication for home it is important to know what the payer will approve. Choosing a medication on the provider approval list certainly helps the patient. If there are medications equally effective it is certainly in the patient's best interest to choose one that is covered. Coming home from a hospital visit can be upsetting enough without telling them that the medication is not covered and they will have a large bill for 6 weeks.
Sterile compounding is a function of both inpatient and home infusion. Most home infusion pharmacies probably did not suffer trying to meet the USP requirements as many inpatient facilities did. Home infusion has been doing many of those things for over 30 years. Many of the companies were also not required to do as much extensive construction as inpatient facilities . The new BPS certification for sterile compounding was originally driven by the home infusion community.
One thing all pharmacists have in common, however, is our commitment to the safety of the patients. Please be patient when a home infusion pharmacist asks you about your patient. And never be reluctant to call a home infusion pharmacist for information when their patient is admitted to the hospital.