Who is a home first-dose candidate?

How you can make the right call

There are numerous areas you need to consider when assessing a patient's ability to receive a first dose in the home. Jim Herbert, RN, CRNI, IHS Homecare's clinical manager for Florida, and Penny Offer, CRNI, the infusion program coordinator for TGC Home Health in Tampa, FL, provide their tips on evaluating patients:

1. Review medical history.

"You should certainly look at the patient's history of allergies, and anyone who has ever had an anaphylactic reaction shouldn't receive a first dose in the home," notes Herbert.

But don't stop at asking about prior anaphylactic reactions.

"Take into account if the patient has a high sensitivity to medications," says Offer. "Do they have respiratory infections a lot? Do they have allergies? Have they ever had a reaction to any medicine?"

2. Consider the drug in question.

"Look at the particular medication and the incidence of anaphylactic reactions," says Offer. "With medications that have a high incidence of reaction, request an anaphylactic kit from the physician. If the drug has a very high incidence, we require the dose be given in a clinical setting."