A mother walks into the emergency department with her infant son. An animal bite has caused an infection and she is told her son needs to receive antibiotics intravenously for a week. Thanks to the Home IV Therapy program, she and her son do not have to stay in hospital for a week. Instead, she takes her son home where she administers the IV antibiotics herself.

The goal of the Home IV Therapy program is to make it possible for patients like this mother and her son to manage their own care in the comfort of their homes, thus opening hospital beds to more critical patients.

RR-2015-08-24-Home-IV-Therapy“From the patient perspective, if you’re stable enough to manage your own therapy at home, it’s a far more comfortable place to be. And from the hospital perspective, if we open those beds to people who are more acutely ill, everybody wins,” says Amy Wiebe, Clinical Manager in the Department of Pharmacy Services at Saskatoon City Hospital.

Before the program was implemented, patients who required IV antibiotics would have only two options when receiving care: to stay in hospital for the duration of their treatment or to return to the emergency department every day, sometimes multiple times a day, to receive IV therapy.

“They would sit in the waiting room for a few hours, get admitted, get their dose, go home, and for some, come back eight hours later and go through the whole process again,” says pharmacist Lee Gallant, adding that this could last up to seven days for some people.

Some short-term (one- to seven-day) infections like skin infections and dental abscesses respond better to IV therapy than to oral antibiotics. The Home IV Therapy program also encompasses patients who require long-term IV therapy for medical ailments like bone infections, diabetic complications and infections that are resistant to oral antibiotics.

“IV therapy is the only reason these patients need to be in hospital, so by providing the Home IV Therapy service we can have patients receive and finish their therapy at home,” explains Wiebe.

Patients are referred to the program by a physician from within the hospital or from the community. Each patient is assessed by Client Patient Access Services (CPAS) and, if eligible, is directed to the pharmacy at City Hospital (open 365 days a year) where their IV medication is processed and can be picked up. The first dose of IV antibiotic is administered in hospital and monitored for any acute adverse reactions. A nurse from Home Care, a community-based program that brings healthcare services directly to clients in their homes, then meets with patients to demonstrate how to administer an IV. The pharmacist follows up with each patient during and after their treatment.

“Our team approach is integral to the success of this program,” says Gallant. “It’s about CPAS, Home Care, pharmacists and physicians working together with patients to support them at home.”

Patient safety is a top priority for the Home IV Therapy program and the team approach ensures that support is continuously available to patients and their families. Currently, there are approximately 40 patients enrolled in the program with length of enrollment varying from a few days to years, depending on client needs. The average length of enrollment is one to six weeks. The program has the capacity for up to 55 patients, so the Patient Flow Follow-on team is working with the program to increase referrals.

“We know there are patients at Royal University Hospital and St. Paul’s Hospital coming to the emergency department for IV antibiotics, and these people would be appropriate for the program,” says Corey Miller, team lead. “We’re in the process of building awareness among physicians and staff in order to increase referrals. The goal is to have more patient-centred care.”

The team is also looking to expand the program to residents in long-term care homes through the community paramedicine pilot. The pilot has made it possible for paramedics to treat seniors in their homes when appropriate, rather than transporting them to the emergency department.

“The more people we can help and safely accommodate with the least amount of barriers, the better,” says Gallant. “Home IV Therapy is a valuable program, and the patients are very appreciative.”