The University Record, April 17, 1995
By Robert Ross
College of Pharmacy
U-M clinical pharmacists Betty Chaffee, Carol Collins and Gundy Sweet are practicing and teaching home care, a specialty that blends inpatient and outpatient pharmacy.
"We're the link between the before and after for hospital patients," Chaffee says. The three clinical assistant professors of pharmacy are members of the Home Medication Infusion Service (HMIS), which includes three nurses and a patient accounts clerk.
"We grab the patients in the beginning, before they're discharged, and walk them through to the safe shore," says Nabil Khalidi, clinical associate professor of pharmacy. An assistant director of pharmacy services at the U-M Hospitals, Khalidi is responsible for administering HMIS.
The patients they serve are no longer sick enough to need highly skilled care in a hospital bed, yet still need intravenously infused medications and nutritional solutions at home.
The home care process starts before patients are discharged, when nurses in the Continuing Care Department refer patients to the HMIS, where the pharmacists evaluate their drug therapy to make sure they are receiving the appropriate drug for the disease and for administration at home.
"We don't want a patient to have to do an infusion at home every four hours," Sweet says. If the patient's medication is to be infused intravenously, the team determines the type of I.V. system to be used in the home. "The type used is important," Collins says. "For example, there are small ambulatory pumps that some physicians don't know about. We also look at the I.V. line to make sure it will last for the duration of their therapy at home and that it goes in a big enough vein for their body to tolerate the medicine."
While patients are still in the hospital, the HMIS team shows them or a care-giver how to administer the solution. "It's not uncommon for us to train several people in the family," Collins says. When the patients are discharged, the team makes sure a visiting nurse is in the home to give the first dose. They also arrange for Home Med, the U-M Hospitals-owned I.V. company, to deliver medications and supplies and schedule nursing visits.
They remain involved until patients no longer need them. "We continue by calling them and seeing them in the clinic," Collins says. "We make sure we get all lab test results. We can make suggestions about dosages, administration and monitoring of the therapy. We act as a liaison. If there's a change in their dosage, we make sure the I.V. company knows."
"We call patients at least once a week and sometimes daily if there are complications in their lab test values or with their I.V. line or access," Sweet says. "Sometimes it's for support when they just need to hear a voice."
The HMIS team members enjoy being on the home care service because of the patient contact, the continuity of care, and the satisfaction of seeing their service pay off.
"Your main purpose is to be with the patient," Chaffee says. "This service offers a huge opportunity to get to know the patient."
"The continuity of care was the reason I got involved with this as a student doing a home care rotation 11 years ago," says Collins, who helped pioneer a home antibiotic program 10 years ago that led to the creation of HMIS. "Not only do you get to know the patient in the hospital, but six weeks down the line you know what happened." Adds Chaffee: "And if they come back into the hospital, you're the link between the before and after."
Sweet likes seeing "the end point of success. The patients are thrilled that their I.V. line is out and they're better. It's pretty neat to be thanked and recognized by a family for how you've helped them."
"Or by grateful physicians," Collins adds.
"I have no doubt that the future is in home care," Khalidi says. "Patients are becoming more educated and knowledgeable about their conditions and what they want and don't want. They favor the home when there's no need for skilled support."