The National Home Infusion Association (NHIA) has released a practice standard for choosing to use electronic mechanical pumps in home infusion settings.
In a Jan. 3 news announcement, NHIA said it had “through its Quality and Standards and Clinical Practice Committees made up of experts in home infusion and alternate site infusion … developed a consensus practice standard to help clinicians assess situations and determine when an electronic mechanical pump is recommended to administer an infusion medication in the home setting.
“The purpose of infusion device selection is to ensure patient safety and minimize adverse events, avoid unplanned hospitalization and emergency room visits, and prevent disruptions in treatment. The pharmacist and nurse are responsible for participating in the selection of an appropriate method of administration to be used in delivering parenteral medications to patients infusing medications at home.”
Providing guidance to home infusion stakeholders
The NHIA released a draft practice standard in October and asked for comments through the start of Nov. 3.
The organization said its practice standards “represent a consensus of professional judgment, expert opinion, and documented evidence.”
The goal of the practice standards is to “provide guidance and direction to NHIA members and other audiences who affect the home infusion industry, and the patients served. Their use may help to comply with federal and state laws and regulations, meet accreditation requirements, and improve patient care.”
The standards are created “to establish reasonable goals, to be progressive and challenging, yet attainable as best practices in applicable home or alternate site settings.” But the practice standards, NHIA added are not the organization’s requirements. “The use of NHIA’s practice standards by members and other practitioners should be assessed and adapted based on independent judgment,” the new standard said.
The Quality and Standards Committee, which NHIA described as comprising home infusion professionals, reviewed available evidence while creating the practice standard. “Clinical and research experts collaborated on the topic, reviewing industry trends and other data sources, such as membership, community, best practices, industry research, review of published literatures, or other practice guidelines,” the practice standard explained.
After the close of the comment period in early November, “the committee reviewed the commentary and proposed revisions. The committee made recommendations prior to being finalized and approved.”
The standard’s audience is “clinicians, regulatory agencies, reimbursement professionals, and industry stakeholders.”
Recommendations for certain infusion scenarios
The standard is divided into two sections.
The first is “Situations where the use of an electronic mechanical pump is strongly recommended to infuse medications in the home.”
Those situations include “Continuously infused medications with a narrow therapeutic index requiring a strictly controlled infusion rate to avoid toxicity and achieve the desired response.”
Examples include infusions of inotropic medications, some chemotherapy medications, and narcotic/opioid patient-controlled analgesia infusions.
NHIA also recommended using an electronic mechanical pump for continuous or extended infusions longer than three hours where dose titration or rate adjustments are required. One such example is parenteral nutrition formulas with titration/ramping parameters.
And the practice standard recommends an electronic mechanical pump for “continuous or extended subcutaneous medication infusions.”
Suggestions for electronic mechanical pump use
The practice standard also listed situations during which clinicians should consider an electronic mechanical pump for home infusion.
Those situations include self-administration of infused medications “prescribed on a dosing frequency where adherence to the prescribed dosing schedule may be difficult or interfere with daily activities.”
One such example would be “an antibiotic administered intermittently three or more times per day.”
Another situation where clinicians should consider an electronic mechanical pump would be “where the administration period or self-administration are not otherwise easily achieved” or for infusion solutions “that require an infusion rate greater than 250 mL per hour.”
And the standard recommends that clinicians consider an electronic mechanical pump “to facilitate administration through a small bore catheter.”
The NHIA said it “welcomes feedback and suggestions” that can be incorporated into revisions and future editions of the practice standards