Survey of CCACs

Ontario’s 43 CCACs have various policies and practices regarding the location of and extent of physician supervision during administration of the first dose of home IV therapy. Of the 29 CCACs that responded to the survey (67% response rate), 21 (72%) indicated that they allow the first dose of IV therapy to be given at home on a case-by-case basis; only 11 (52%) of these 21 CCACs had specific inclusion or exclusion criteria for initiation of home IV therapy. Inclusion criteria for administering the first dose at home under a nurse’s supervision included recent use of the drug without complications, referrals from the community, and indications specific to the type of drug given and concurrent medications. For example, patients are not approved for home IV therapy if they are receiving ^-blockers or anti-adrenergics, as these medications can attenuate the therapeutic effects of epinephrine administered for anaphylaxis.

In some jurisdictions, the contracted nursing agencies dictate the eligibility criteria for patients to receive the first dose at home. These policies give consideration to safety issues for both the patient (e.g., adverse drug reactions) and the nurse involved (e.g., remoteness of the client’s home and travel restrictions imposed by adverse weather conditions). At least 3 CCAC respondents commented that most contracted nursing agencies are reluctant to administer the first dose at home because of the potential legal implications of assuming full responsibility for the patient’s safety. viagra 50 mg

Surveys of Health Care Professionals

Different versions of the survey were sent to the 2 groups of health care professionals (physicians and pharmacists), so the responses were not combined. The response rate was low: 18/254 (7%) and 10/220 (5%) for the CIDS and PSN surveys, respectively. Most respondents in both groups had policies specifying that the first dose of IV antibiotic be administered in hospital. One policy waived the requirement that the first dose be given under direct medical supervision for patients who had previously received the same antibiotic class from home care. Another policy allowed first-dose IV administration without direct medical supervision for clients receiving palliative care who had “do not resuscitate” orders and who had given informed consent after being advised of the risks of a severe reaction. Most pharmacist respondents who had policies regarding epinephrine availability required visiting nurses to carry epinephrine at all times.