Home IV facilities outdo hospitals in QA programs

Survey: Home care staff take on more responsibility

A study of hospital pharmacy and home infusion directors on quality assurance (QA) programs for the preparation of sterile products has found that home infusion facilities were more likely to have QA programs in place, that their staff carry more responsibility for sterile product preparation, and that they are more likely to implement written policies and procedures than their hospital counterparts.

The study, which appears in the November 1996 issue of American Journal of Health System Pharmacists, was conduced in May 1995, and was a follow-up to a 1991 study conducted by the American Society of Health System Pharmacists.1

In that study, only hospitals were surveyed about quality assurance procedures, and the society found there were no guidelines addressing such programs. Since then, the society has published guidelines. This study was an effort to determine if the guidelines had had an impact.

Among the items respondents were asked about were extemporaneous and batch preparation of products. Of the 109 home infusion facilities that responded, 83 (76.1%) had automated filling devices, and 74 of those 83 had written QA policies on those devises. In hospitals, only 41.2% used such devices, and only 77.4% of those hospitals had written policies on the automatic devices.

Home infusion staff also were more likely to have more responsibility for the extemporaneous preparation of sterile products — 58.7%, compared to 34.7% among hospitals. "These findings suggest that technicians working in home infusion facilities carry more responsibility in the area of sterile product preparation than their hospital counterparts," says the study.

Hospitals also came in behind home infusion in the area of having written policies and procedures on a variety of issues, including quality assurance and education and training. Both pharmacists and technicians at home infusion facilities outperformed hospital staff in these areas.

Hospitals also are less likely to conduct environmental tests to determine if there is microbial contamination in the workplace. Of the 519 hospitals responding, 34.5% sampled air inside the laminar-airflow hood work space, compared to 56.9% of home infusion facilities. Both hospitals and home infusion were about equal — 32% and 33% respectively — in sampling the hood surface itself. But 33.9% of infusion facilities would sample floors or walls, compared to just 6.9% of the hospitals. And fully half of the hospitals said that none of the mentioned areas were sampled, compared to just a fifth of the infusion facilities.

Survey can provide QI benchmark

The survey authors comment on the relatively strong performance of the home infusion facilities. "This survey . . . highlights the differences in quality assurance activities between hospital and home infusion facilities," state the authors, "and thus can provide a benchmark for quality improvement actions in selected areas. In many cases, the findings for home infusion facilities indicate a higher level of quality assurance for pharmacy-prepared sterile products than in hospitals."

But the authors are unsure why home infusion outperforms its hospital counterparts. "One possibility: 1995 Joint Commission standards are more explicit in defining quality related to sterile product preparation in home care facilities than in hospitals."

Reference

1. Santell JP, Kamalich RF. National survey of quality assurance activities for pharmacy-prepared sterile products in hospitals and home infusion facilities — 1995. Am J Health-Syst Pharm 1996; 53:2591.

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