Home Infusion Nurse Time for Intravenous Immune Globulin: Findings From a Multi-Center Observational Time Study

Vollständiger Abstract

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Introduction Home administered intravenous immune globulin (IVIG) is well established as a patient-centered alternative to facility-based infusion. Safe delivery of home based IVIG relies on appropriate infusion support, which may include an infusion nurse to prepare and administer therapy, monitor the patient’s response, perform vascular access care, provide patient education, coordinate care, and communicate with the interdisciplinary team. This study quantified nurse time and task distribution associated with home infusion of IVIG during the early phase of therapy. Methods The National Home Infusion Foundation conducted a descriptive, observational, multicenter nurse time study among home and specialty infusion providers. Nurses used standardized data collection tools to retrospectively record time spent on IVIG-related nurse tasks performed in and outside the patient’s home. Data was analyzed for patients meeting inclusion criteria for IVIG initiated in the home. Nurse tasks were quantified and grouped into 8 categories while nurses’ time was summarized by visit. Just as important, nurses’ travel time and patient drug administration times were also calculated. The IVIG-related nurse tasks and times were compared to antiinfective and monoclonal antibody data. Results Nineteen IVIG patient cases met inclusion criteria and were submitted by 7 providers. The mean patient age was 53.53 years. Across 3 nursing visits, 198 nurse tasks were documented. More than half of all tasks occurred during Visit 1, and the most frequently reported task categories included drug administration, vascular access device care, laboratory monitoring, and patient assessment and documentation. Mean drug administration time was 3 hours and 58 minutes, with substantial variability across patients. Compared with anti-infective and monoclonal antibody administration times, IVIG takes considerably longer, increasing overall nurse time. Mean round-trip nurse travel time was 1 hour and 16 minutes. Nurse tasks performed outside of the home which included care coordination,documentation, and telephonic communication, contributed to additional time that was not captured during the patient-facing infusion time. Conclusion While it is well known that IG requires more nurse time, it has not been measured. The study determined that IVIG requires more nurse time than anti-infective and monoclonal antibody therapies. These findings highlight that the nursing workload associated with home-based IVIG extends beyond direct in-home infusion administration.