Give your business a boost with blood transfusions

Potential referral sources may be right next door

Unless a patient is discharged from the hospital or similar inpatient setting, it may seem as though there’s not much more you can do for them than their current health care provider is already doing. But with the numerous new therapies available to home infusion providers, you don’t have to wait for a patient to be discharged home for the individual to become a patient.

SunPlus Home Health Services in Upland, CA, provides an array of services that include providing blood transfusions in patients’ homes. But Marilyn Ruzicka, RN, CRNI, the regional director of infusion for SunPlus, says transfusions provided to patients in skilled nursing facilities have become the niche they’ve been most successful marketing to. Never overlook potential referral sources.

Ruzicka notes that there’s a very select patient group that requires blood transfusions in the home. "Generally it’s oncology patients," she says. "The biological drugs have cut out a lot of the transfusions, although those drugs are expensive. Also, Medicare doesn’t cover blood transfusions in the home."

Oncology patients are good candidates for home blood transfusions for several reasons, says Ruzicka.

"They are often immunocompromised and have low white blood cell counts," she says. "If they’re on chemotherapy, they don’t want to be exposed to a lot of germs, and the hospital is probably the last place they’d want to be."

Another patient population that SunPlus provides blood transfusions to are those on kidney dialysis. "We get the blood and bring it to the dialysis nurse, who practically gives the blood transfusion," says Ruzicka. "They give the blood during the dialysis, so it takes just 15 minutes in some cases."

Ruzicka notes that the cost of receiving a transfusion in the home is frequently much less than having a patient transported to the hospital, particularly for oncology patients. By using SunPlus, the managed care or insurance company can skip the cost of the ambulance ride to and from the hospital, which is often necessary to transport such patients.

That cost benefit has helped SunPlus expand its referral base to area skilled nursing facilities and thus moved into alternate site transfusions.

"Our parent organization has a lot of skilled nursing facilities, so we are often requested to provide the blood transfusions within those skilled nursing facilities," says Ruzicka. "Skilled nursing facilities often have managed care contracts that are eager to find alternate approaches to provide transfusion therapy.

"If you can get a good payment negotiated, it still comes out less than what the managed care company would pay to transfer that patient to the hospital, give the infusion there, and transfer that patient back," says Ruzicka.

It’s also to the skilled nursing facility’s benefit to keep the patient. "They want to keep their beds filled, so if they can go to a managed care company and say, ‘We can keep this patient here and do a blood transfusion cheaper,’ it makes the managed care company and the facility happy, as well as the caregiver and loved ones because the patient isn’t being moved around."

When going into a facility, the care provided is no different from when going into the home, although extra education is required. "While we’re at the facility, we are one-on-one with the patient," notes Ruzicka. "Then we stay for 20 or 30 minutes after the transfusion or longer if necessary. We also teach the person that’s taking care of the patient the signs and symptoms for any problems that might arise."Ruzicka notes there are two predominant reasons such facilities don’t give blood transfusions:

Staff.

"Turnover in the skilled nursing facilities is high, and to train those nurses to do blood transfusions can be costly and inefficient," says Ruzicka.

Working with blood banks.

Because blood banks can be very specific regarding the guidelines they require of an agency and its staff to pick up blood, some providers choose to skip the hassle altogether and outsource transfusions.

There’s more to providing a blood transfusion than meets the eye. While the transfusion itself takes anywhere from two to four hours, Ruzicka says SunPlus allows eight hours of time over two days.

The day prior to the transfusion, a nurse will visit the patient and draw blood, which is taken immediately to the blood bank. Because each bank has particular information it wants on the blood label and its own forms that must be filled out, having staff that are familiar with each blood bank ensures that the process goes smoothly.

The next day, a second visit to the blood bank is required to pick up the blood.

After completing yet more forms prior to receiving the blood, the blood is delivered to the patient, and a nurse performs the transfusion.

Because a patient reaction is always a distinct possibility, SunPlus takes the following precautionary measures, among other steps:

1. Require an anaphylaxis kit.

2. Coordinate with the physician as appropriate for the transfusion.

"We require that the physician is available by phone or by pager in the event there is a reaction," says Ruzicka.

SunPlus requires a four-hour blood transfusion inservice for any staff member that will be administering transfusions. The inservice is a formal four-hour class, in which various tools and techniques are used. (See chart, pp. 16-17.)

In addition to the clinical instruction necessary, Ruzicka points out that meeting the needs and particular requirements of each individual blood bank is very important.

Before you work with any blood bank, Ruzicka notes that they’ll request to see your policies and procedures for their review.

"They want to see that you’ve got everything mapped out and that you’ve gone by the AABB [American Association of Blood Banks] guidelines," says Ruzicka. The AABB sets the standards on how blood is delivered by blood banks.

To avoid any potential problems, Ruzicka recommends using the AABB, as well as doing your homework to see if anyone in your community is already offering blood transfusions.

[Editor’s note: The AABB can be reached at (301) 907-6977, or by visiting its Web site at www.aabb.org.] n