Providing Specialty Therapy in the Home

How aware are specialty pharmacists regarding the legal and ethical implications related to the home care nurses they hire? Here are some professional issues facing nurses as they work in tandem with specialty pharmacists.

Nurses are required to abide by laws and regulations when practicing nursing. Not abiding by the code of ethics could cost the nurse his or her nursing license and result in a malpractice suite. The nurse has the responsibility to practice within his/her scope of care. How aware are specialty pharmacists regarding the legal and ethical implications related to the home care nurse they hire? This article touches on some important professional issues that nurses encounter while providing specialty therapies in the home.

At the time of the initial patient and home assessment, it is the nurse’s responsibility to assess and report to the physician and pharmacy the following: 1) the patient’s ability to receive the medication; 2) who will be administering the therapy; 3) is the home environment safe and appropriate for the care; 4) any specific interventions required to accomplish the expected outcomes; and 5) evaluation of the patient’s support system. Once the plan of care is established, the nurse provides instruction to the patient and caregiver(s) regarding the patient’s particular disease and treatment in order to help the patient achieve an agreed-upon plan of care.

It is important for the specialty pharmacy to coordinate care with a nurse who best understands the patient’s culture and background to meet the needs of the patient. Differences among nurses, including their level of education, years of work experience, type of work experience, and level of cultural competence (cross-cultural sensitivity) all influence care delivery to some extent.

Legal Considerations

The legal considerations connected with delivering care in a patient’s home are similar to those of care delivered in health care facilities, but have additional aspects. A common legal nursing consideration in specialty pharmacy is “first dosing.” Home care agencies are reluctant to administer first dosing in the home or blood products due to the legal liability. Specialty pharmacies may request first dosing and blood products in the home to expedite the delivery of services.

What is important to understand from the nursing perspective in the home setting is that the nurse may be the only person available to attend to the patient experiencing the anaphylactic reaction and must make emergency medical decisions. It is essential for the nurse to follow processes, protocols, and standards of practice to keep free of legal liability. Not all nurses are prepared for such an occurrence, which puts both the nurse and the agency at risk.

Another common legal consideration with regard to the nurse’s encounter, while administering therapies in the home, involves the knowledge or suspicion of abuse of a member of the family. This has little to do with the actual administration of the drug, but definitely falls under the legal liability of the nurse’s license to report to proper authorities.

Nurses often encounter ethical implications which are closely tied to legal implications in the home care setting. The patient is in his or her own residence and has the legal right to do as he or she chooses. The nurse may arrive to administer a therapy for a patient and find that the patient is consuming drugs or alcohol. The nurse must evaluate the liability if he/she provides the service versus the ethical implication if the nurse does not.

Complex ethical issues are not always addressed in policy statements. Ongoing communication between the nurse and the specialty pharmacy is essential to address problematic situations.

Safety Issues

Nurses may experience safety issues in home care requiring immediate attention and vigilance. The nurse does not have security protection readily available if a family member becomes violent toward either the health care worker or the patient. Nurses are required to visit patients in high-crime areas or after dark. Specialty pharmacies need to be aware of the home environment the nurse is going to.

Nurses are held to a holistic responsibility of the patient, family, and home environment once they enter the home. Even though their assigned task is to administer a medication or perform a teaching on behalf of the specialty pharmacy, their nursing license calls upon their knowledge and skills to make decisions in the best interest of the patient while in their presence.

About the Author

Cherylann Gregory, RN, BSN, is founder and president of the Specialty Pharmacy Nursing Network (SPNN) and has more than 30 years of experience as an oncology/ infusion nurse. SPNN provides a nationwide network of 500 qualified nurses for specialty pharmacies and biotech manufacturers. Services include coordination of care, drug administration, first dosing, education, clinical outcome data collection and reporting, and on-call coverage for specialty therapies. Visit www.spnninc .com for more information.