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).