Training patients to administer intravenous antibiotics at home

A home intravenous antibiotic infusion program (HIAP) implemented in a 256-bed, nonteaching, primary-care hospital is described. Physicians initiate participation in the program by referring a patient to clinical pharmacists and intravenous team nurses. Patients are evaluated on the basis of the following five criteria: (1) the infectious process has responded clinically to treatment, the patient has been afebrile for at least five days, and the physician has noted that the patient could be discharged if continued i.v. antibiotic therapy were not necessary; (2) the patient has successfully completed the pharmacist's teaching sessions on aseptic technique, the heparin-lock system, and the mechanics of i.v. antibiotic piggyback administration; (3) the patient has a family member or close friend who can attend the patient instruction sessions; (4) the patient has reasonably good veins, i.e., they have not readily developed phlebitis or heparin-lock occlusions, and there are a number of viable sites or the antecubital veins are accessible for insertion of a catheter, if necessary; and (5) a preliminary cost comparison indicates that the patient's participation in the HIAP would result in a cost savings. The therapeutic results of the HIAP were considered successful by the physicians. The i.v. team nurses noted no increase in heparin-lock site problems. The pharmacists spent an average of four hours teaching the HIAP patients, at a rate of $25 per hour. This cost was billed as a part of pharmacy services. Most of the insurance companies were willing to pay the entire charge for the HIAP. For eight patients treated in the program, savings of 128 bed-days and $18,968 were shown. the HIAP was found to be successful in terms of medical treatment and cost containment in a medium-sized, primary-care hospital.