Onboarding Home Infusion Anti-Infective Patients: A Descriptive Study of Nurse and Pharmacist Time

Vollständiger Abstract

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Introduction Home infusion anti-infective therapy is an important component of post-acute care, allowing patients to transition more quickly from facility-based treatment to home-based intravenous therapy. The patient onboarding phase is a critical and resource-intensive period that requires coordinated activities by nurses and pharmacists, including clinical assessment, care planning, medication preparation, patient education, documentation, and communication with prescribers and other care team members. Home infusion providers invest professional time toward patient onboarding before payment begins, and a significant proportion of referred patients may not ultimately receive billable home infusion services. Limited evidence exists quantifying the combined nursing and pharmacist time required to onboard home infusion anti-infective patients. This study evaluated the time and task distribution associated with nurse and pharmacist tasks during patient onboarding activities for home infusion anti-infective therapy. Methods The National Home Infusion Foundation conducted descriptive, observational time studies among home and specialty infusion providers. Nurses and pharmacists used standardized data collection tools to retrospectively record time spent on anti-infective patient care tasks. Patient onboarding tasks for nurses were defined as activities completed before the first nurse visit to the patient’s home. Pharmacist onboarding time included patient care activities from referral through the first dispensing of the home infusion medication. Task frequencies, percentages, and mean time by task category were analyzed for anti-infective patients. Results Among 28 anti-infective patients in the nurse time study, 14 had patient onboarding tasks completed before the first nurse visit. Nurses completed 68 patient onboarding tasks, averaging 4.86 tasks per patient. The most common patient onboarding task category was care coordination and telephonic communication, accounting for 41.18% of nurse tasks, followed by patient assessment and documentation at 29.41%. Patient education required the greatest mean nurse time per task at 29 minutes. Pharmacist tasks for patient onboarding data included 22 anti-infective patients and 129 tasks, averaging 5.86 tasks per patient. Most pharmacist tasks involved drug preparation and compounding activities, representing 44.19% of pharmacist tasks for onboarding patients, followed by patient assessment and documentation at 27.13%. The most time-intensive pharmacist task category was patient assessment and documentation, averaging 45 minutes per task. Combined patient onboarding time demonstrated substantial multidisciplinary effort, with nurse and pharmacist activities contributing an average of more than 4 hours of professional time before or during therapy initiation. Conclusion: Onboarding home infusion anti-infective patients requires substantial nurse and pharmacist time before therapy is fully initiated in the home. Nurse activities were concentrated in care coordination, communication, assessment, and patient education, while pharmacist activities centered on drug preparation, compounding, assessment, documentation, and care coordination. These findings highlight the multidisciplinary and frontloaded nature of home infusion patient onboarding and provide data to inform staffing models, workflow planning, and reimbursement discussions for homebased anti-infective therapy.