Homecare Highlight: Nurses Provide Specialty Infusions in Patient Homes

In the past 5 years, home healthcare has seen tremendous growth. An article published in HomeCare Magazine cited home health as leading all U.S. healthcare sectors in job growth at 4.4 percent growth from March 2018 to March 2019, equating to more than 64,000 additional jobs.

And, while all areas of home health are expanding, one growth area in particular is at-home specialty infusion therapy. In 2019, home infusion and specialty providers cared for more than 3 million U.S. patients, according to the National Home Infusion Association – a 300 percent increase from 2008.

Leanna Huffman, BSN, RN, is the Nurse Manager for Cleveland Clinic’s Center for Connected Care, which brings together all home and transitional care services, and she was integral in the launch of Cleveland Clinic’s at-home specialty infusion nursing program.

Huffman came to Cleveland Clinic in 2017, with a vast background in at-home specialty infusions. At the time, Cleveland Clinic’s homecare team was providing at-home infusions for post-acute patients; however, the health system didn’t have an at-home infusion department specific to outpatient specialty infusions. These infusions are commonly categorized as infusions for patients who suffer from chronic conditions like multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), severe respiratory complications, immunodeficiencies, rheumatoid arthritis and cystic fibrosis, and more.

After much planning and preparation, Huffman and a team of four highly trained specialty infusion nurses became the first members of Cleveland Clinic’s at-home specialty infusion nursing team in 2019. In just one year, with the increased interest of patients wanting more convenient at-home care, the rise of commercial payors covering at-home care services, and the COVID-19 pandemic creating a need for more creative ways to deliver care, the specialty infusion nursing team continues to see an increasing number of patients.

An overview: at home specialty infusion nursing services

Specialty infusion nurses administer medications to patients through a needle via standard intravenous (IV) administration or catheter such as through a peripherally inserted central catheter (PICC) line or medical port. The types of patients Cleveland Clinic’s specialty infusion nurses most often care for are those with chronic diseases who were diagnosed or previously treated in an outpatient physician office setting and have an established care plan.

“A lot of our patients are working full-time and are trying to manage their chronic disease with minimal disruption to their daily lives,” says Huffman. “There are many reasons why patients seek at-home specialty infusion services. For example, some come to us solely for the convenience of receiving their medication in home. In other cases, maybe the patient was taking a steroid or other oral medication, but that form of treatment is no longer working so they need an infusion medication. Or, a patient may opt to change therapies, from a medication that can only be given in the inpatient setting to another medication that they can take at home. And, of course there’s the evolution of medications and treatments that become available – for example, a name brand medication now has a generic form that can be administered in the home.”

In almost every case, Cleveland Clinic’s specialty infusion nurses are in a patient’s home at least once every 2-4 weeks, depending on the patient’s medication regimen, so detailed patient scheduling, communication with the pharmacy team and an organized intake department are very important. Huffman says Susan Kurcz, RN, WTA, a Cleveland Clinic home healthcare case manager and specialty infusion nurse, was instrumental in establishing process and organization for her team’s intake department.

“There are some medications, like one for MS that is delivered two times per year with a 3-4 hour infusion, another for Crohn’s disease that is initiated every two weeks via a 30-minute infusion for the first 8 weeks then every 8 weeks thereafter, and others like one for ALS that repeats an ongoing cycle of daily infusions for 10 days, followed by a drug-free period for 14 days,” Huffman says.

Highly trained for innovative care delivery

Specialty infusion nurses are highly trained – and, rightfully so, as they don’t generally have access to the traditional tools and resources that are available with inpatient infusion delivery, yet they perform the same services as inpatient infusion nurses.

“In-home infusions can be challenging so our nurses have to be top-notch to ensure superior patient comfort and safety within each care environment,” Huffman says. “For example, it might be a dark, rainy day and the patient’s home may have minimal lighting. Or, the patient may sit in a recliner or at a desk chair to receive their infusion, which isn’t as convenient as a typical infusion chair would be.”

Many specialty infusions require several hours of time – sometimes up to 8 hours or more – to complete, so at-home patients need to be able to move as freely as possible during the administration process. Specialty infusion nurses are on-site the entire time to oversee the infusion, observe any signs of medication reaction, ensure patient safety and complete patient charting.

In addition to infusing the medication, specialty infusion nurses also compound, or mix, the medications in the patient’s home. Medications can be shipped directly to a patient’s home via powder vials and bags of saline. Every medication is volatile and must be administered within a set amount of time after mixing, which Huffman says can be as minimal as 2 and 4 hours. Additionally, most medications are refrigerated so infusion nurses also need to remind patients to remove the medication from the refrigerator prior to their arrival to reduce the discomfort of receiving a cold infusion.

“One of the things I enjoy most about my position as a home infusion nurse is the relationships with my patients,” says Kurcz. “How well I get to know my patients significantly impacts my ability to case manage in a positive way. Working closely with patients and their physicians allows for a much more collaborative approach to a plan of care.”

Frequently, and any time a new medication is released, the specialty infusion team receives medication training from pharmaceutical sales representatives and clinical nursing educators.

“I also really enjoy the pharmaceutical side of infusion nursing,” Kurcz adds. “Getting education on new infusions and learning about the innovative ways to treat long-standing chronic and autoimmune disorders is fascinating.”

Offering career flexibility and stability

Kurcz notes that working as an infusion nurse offers a work schedule that is both flexible and stable.

“Because of the repetitive nature of my visits, I am able to have the bones of my schedule ahead of time,” Kurcz comments. “Also, all of my patients are flexible with their infusions if need be and my specialty infusion nurse colleagues are always there for me and each other – without question.”

Huffman agrees: “Our specialty infusion nurses are very committed to flexible scheduling for our patients and we all work closely together, making our patients and each other a priority.”

Huffman adds that a lot of specialty infusion nurses, and other homecare nurses, now work from home too, which offers even more flexibility.

In her role, Huffman manages approximately 35 Cleveland Clinic nurses within the organization’s home health umbrella. Other nurses on her team provide post-acute at-home infusions through shorter 1-hour visits for patients who have recently been discharged from an inpatient hospital stay and require a combination of skilled nursing care with an infusion.

As with the specialty infusion positions, float nurse positions are also extremely flexible, with options for evening and day shifts. Cleveland Clinic continues to expand this area of at-home nursing care. View Cleveland Clinic Connected Care job opportunities.