1. Hinck, Susan M. PhD, APRN, GCNS-BC

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Q: How can I implement the 2021 Infusion Therapy Standards of Practice in my agency?


Infusion therapy programs provide medication, fluids, and total parenteral nutrition intravenously, as well as phlebotomy services, to patients (Fields et al., 2020). The Infusion Nurses Society recently published revised recommendations for safe care in all settings, including home care (Gorski, 2021). Agency actions should include updating current policy and procedures according to the 2021 Infusion Therapy Standards of practice. New in the 2021 standards is administration of the first dose of medication in the home setting. The agency may decide whether to incorporate this practice along with the conditions for safe administration. To support safe infusion therapy, the home health and hospice agency is responsible to:


* Communicate current written policies and procedures to staff,


* Supply sufficient personnel, equipment, and supplies for patient care, and


* Ensure that staff are competent to perform their responsibilities.



When considering patients for admission, intake staff need to know:


* Type of infusion medication and solutions such as hydration fluids, parenteral nutrition, opioids, inotropes that alter muscular contractions, and chemotherapy (antineoplastics), some of which are vesicants that can damage tissue if displaced from the vein.


* Type of infusion device such as gravity infusion, syringes for IV push, specialty medication containers such as an elastomeric positive pressure medicine ball, and electronic pumps that require programing.


* Pharmacy name and umber, and supplies that will be included.


* Whether blood specimens are to be routinely obtained for laboratory tests, which laboratory is to be used, and to whom the test results are to be sent.



The agency needs to know what the agency is responsible to supply before admitting the patient. A pharmacy usually directly bills the insurance company for the medication or solution and supplies, but the agency should clarify this. In addition, the number of visits required for the nurse to administer the medication or teach the patient/caregiver safe management and administration may not be authorized or reimbursed by the insurance company. If the agency admits the patient to service, the agency must provide the quantity and quality of care the patient needs, even if the insurance does not reimburse all visits and supplies.


Staff Competency

The agency must have a rigorous education and competency testing program for nurses participating in infusion treatment. The nurse must know both the psychomotor steps and the rationale for each action, and be able to teach the patient. Documentation of competency extends beyond a self-report checklist and includes knowledge testing, such as written tests, and demonstration to clinical educators or preceptors. Because some agencies do not have specialized clinical educators, the agency may consider contracting with an infusion therapy expert or educator for periodic presentations on procedures and psychomotor practice.


Even a small agency can invest in a simulation model for infusion therapy to use for routine teaching and psychomotor practice, and for nurses to drop-in to practice so that the process is automatic and not faltering in the patient's home. Practice with a model allows review of the steps of gathering supplies, performing the procedure, and talking through patient teaching.




Fields B. E., Whitney R. L., Bell J. F. (2020). Managing home infusion therapy. The American Journal of Nursing, 120(12), 53-59.[Context Link]


Gorski L. A. (2021). A look at 2021 infusion therapy standards of practice. Home Healthcare Now, 39(2), 62-71.[Context Link]