Being an active 58-year-old, David never imagined he would need four months of intravenous (IV) antibiotics for an infection in his spine. “I had a lot of concerns about long-term antibiotic use and developing antibiotic resistance, but my pharmacist, Diana, was there to support me every step of the way.”
At VGH, BC’s only pharmacist-led Home IV Antibiotic Program has been operating for 21 years. It allows patients who require long-term IV antibiotics to return home, rather than endure a prolonged hospital stay.
As a clinical pharmacist with the program, Diana Tsang conducts the initial assessment to determine the appropriateness of the patient’s antibiotic therapy and patient eligibility for the Home IV Program. She then works closely with the infectious disease physicians to finalize the antibiotic regimen and coordinates seamless discharge back into the community — and that’s just the beginning.
During initial assessments Diana ensures that the patient and family are able to manage care at home. She spends an extensive amount of time explaining the treatment, potential side-effects, possible drug interactions, required follow-up and monitoring, as well as the process of receiving antibiotics delivered to their home.
“The model of Home IV has changed dramatically over the years,” says Diana. “The program today requires patients and families to participate more actively in their own therapies by learning to self-administer medications and to receive nursing care at ambulatory clinics.”
David, like many other patients, felt overwhelmed by the prospect of transitioning to Home IV. “While I was in hospital, Diana came to see me to make all the necessary arrangements and to explain the process, including what my options were,” he says. After discharge, Diana provided ongoing education and peace of mind.
“Since my discharge I have contacted Diana many times to ask about my medications and to bring her up-to-date on my health status. She’s always present at my follow-up appointments with the infectious disease doctor to provide updates on my progress and participate in the decision of further care.”
Ongoing follow-up is very important to monitor for side-effects and other complications, and to minimize the risks for developing antibiotic resistance. Patients are required to get regular bloodwork, which allows Diana, as the medication expert, to promptly address any drug-related issues and assist physicians in ongoing care.
“Diana has great bedside manner and has always been very accessible,” says David. “Even when I was in considerable pain due to my infection and was taking [strong painkillers], Diana helped me assess my options for pain management and make a safe transition to an [alternative regimen].”
Diana says that her days can get very busy as the program is widely utilized at VGH. “I work with an amazing team of people to make Home IV possible for our patients: physicians, infusion team nurses, clinical pharmacists on the infectious disease service, community nurses, unit coordinators and all the administrative staff.”
After four months, David is finally finished with his treatment. When asked, he confides that without Diana’s support, there’s a chance he wouldn’t have stayed on course with his Home IV therapy. “Diana has been an advocate for my health and a big component of my healing process.”