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Carole Rumsey
I work in home care and am wondering if anyone else has worked with patients receiving Remodulin?  We have been asked to admit to our service patients who have other infusion needs (usually IV ABX for some type of infection).  We are told by the infusion pharmacies that have the national contract for Remodulin, not to worry about their med or infusion pump because patient/caregiver is independent.  We are only suppose to care for the patient's "other" infusion needs.  I am concerned about the legal ramifications in caring for an infusion patient where I do not have any knowledge or competency trained on one of their infusion pumps.  Can we inform the MD and ask for an order to only caring for the IV ABX needs and equipment related to that need and have the national infusion pharmacy care and provide for the Remodulin needs?  Any thoughts/suggestions?
mary ann ferrannini
  I also work for a home
  I also work for a home infusion company and although I have never encountered this exact scenario I have had situations where we  were requested to provide certain therapies. Often times the patient was receiving other nursing services (including IV therapies) from different companies or agencies. The MD requesting the antibiotics should be aware that you will only be providing nursing services for those medications prescribed and for insertion ( If applicable) and maintenance of whatever type of VAD you are using. The issue here might be to not in any way to interrupt or disturb the Remodulin administration. So,for example,if patient is receiving the medication through a SL port,there must be another VAD. This does not relieve you of the duty of performing an assesment though. So if you assess a problem that could be related to the Remodulin infusion you should inform the MD. The patients on continuous IV medications via an ambulatory pump know their pumps very well (their life depends upon it!). You do not have to assist them with their  Remodulin pumps at all. If for some reason they need help they are to contact the agency or company that initiated the service. That is what I have done in the past. Hope this helps.
Chris Cavanaugh
Remodulin is only sold
Remodulin is only sold through a select group of specialty pharmacies, who manage their patients with their own nurseing, both inperson and via phone.  This case has to be a collaboration.  As soon as you take on the patient, you become the "eyes and ears" for the Remodulin pharmacy staff.  Let them know who you are, and why you are seeing the patient.  If anything happens to the pump, lines or infusion, you should contact them and the MD immediately.  The patient's MD should be aware of the Remodulin infusion, and if he is not (not every doc talks to another), you need to notify the MD that has given you the orders.  These patients are independent with their Remodulin therapy, and can become independent very quickly with any other IV therapies you may have for them.  Liablity wise, it is your responsiblity to report what you see if there is a problem, and defer to the other company for guidence.  Communication is the key.

Chris Cavanaugh, RN, BSN, CRNI, VA-BC

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