Page 300 - Medicare Benefit Policy Manual

Consistent with section 1861(iii)(2)(B) of the Act, qualified home infusion suppliers are
required to provide patient training and education, not otherwise paid for as durable
medical equipment, and as described in 42 CFR 424.57(c)(12). In addition, the patient
training and education requirements are consistent with standards that are already in
place, as established by the current accrediting organizations of home infusion therapy
suppliers. This is a best practice, as home infusion therapy may entail the use of
equipment and supplies with which patients’ may not be comfortable or familiar.

Hygiene Training and Maintenance of Vascular Access Devices

Many beneficiaries receiving home infusion therapy may have a unique need for a central
vascular access device (CVAD) that requires training and education regarding
maintenance and hygiene. This may include education regarding properly disinfecting
access points and connectors, dressing changes, and recommended actions in the event of
a dislodgement, occlusion, and signs of infection. This also includes teaching the patient
about flushing the CVAD after the infusion to ensure all of the medication has been
flushed through the tubing and catheter, and locking the catheter to prevent blood from
backing into the catheter and clotting. Education regarding specific techniques and
solutions (saline or heparin) may also be given to minimize catheter occlusion.

Medication and Disease Management

The qualified home infusion therapy supplier is responsible for ensuring the patient has
been properly educated about his/her disease, medication therapy, and lifestyle changes.
This could include self-monitoring instruction (nutrition, temperature, blood pressure,
heart rate, daily weight, abdominal girth measurement, edema, urine output) and
identification of complications or problems necessitating a patient call to the designated
infusion clinician (nurse, pharmacist, or physician), or emergency protocols if they arise.
The qualified home infusion therapy supplier should ensure the patient’s proper
understanding of the medication therapy including: drug, route of administration,
prescription (dosage, how often to administer, and duration of therapy), side effects and
interactions with other medications, adverse reactions to therapy, goals of therapy and
indications of progress. Lifestyle education regarding behavior and food/fluid
modifications/restrictions, symptom management, and infection control are also
important aspects of patient education.

While the durable medical equipment supplier is responsible for training the patient and
caregiver on the infusion pump operation, maintenance, and troubleshooting, the
qualified home infusion therapy supplier would be responsible for all other aspects of
medication administration. These services may include inspection of medications,
containers, and supplies prior to use; proper drug storage and disposal; hand hygiene and
aseptic technique; education on pre/post medication/hydration administration; and
training on medication preparation. Household precautions for chemotherapy drugs
including spills, handling body wastes, and physical contact precautions must also be
addressed.
Patient Assessment and Evaluation