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Vascular Access/IV

Collaborating for excellence in patient care: first parenteral dose administration in home and community care

03 April 2025
Canadian Vascular Access Association
02 April 2025
Volume 34 · Issue 7
Healthcare professional

Abstract

With a lack of standard processes in first parenteral dose medication administration in the home and community setting, a quality improvement initiative was undertaken by provincial home and community care service provider organizations (SPOs) in Ontario to support an evidence-based practice approach for administering the first dose of an intravenous (IV) medication. The project group, consisting of clinical leaders and business competitors, united to collaborate and support evidence-based, safe patient care. The group developed an evidence-based approach to screening patients for safe administration of the first dose of a parenteral medication within the home and community setting.

Aligning the practice of administering the first dose of a parenteral medication is critical to providing safe, consistent, equitable, and timely care for all patients requiring a first dose in the home and community setting. From the SPO perspective, this improvement initiative has achieved the primary goal of aligning on a consistent patient safety screening tool used to support determining if first dose administration of a parenteral medication in the community is safe for the patient.

Outputs of this work include collaborating with the provincial government funder and with SPOs who are competing for the same contracts within this sector, and the development of evidence-based resources to support patient screening. An exciting outcome was the opportunity to align with the Canadian Vascular Access Association (CVAA) and their mission statement of advocating for safe, quality patient care across the healthcare system (CVAA, n.d.). By developing an evidence-based approach to administering the first dose of a parenteral medication, this group has advocated for CVAA to include elements of the quality improvement (QI) initiative within the newly updated 2024 CVAA guidelines.

This manuscript outlines the continued and thorough process undertaken by SPOs and the provincial government funder for home and community care to standardize best practices for administering a first dose of a parenteral medication in this unique sector. The successes and challenges encountered in aligning all those with a vested interest are highlighted.

A collaborative project to support evidence-based practice and continuous quality improvement (QI) was undertaken by six service provider organizations (SPOs). These SPOs are members of the Ontario Provincial Nursing Practice Council (NPC) and the Provincial Clinical Practice Subcommittee (CPS), a branch of the NPC. The CPS undertook this QI work with the goal of standardizing the process of administering a first dose of a parenteral medication in the community setting.

A three-year project ensued, resulting in the development of guiding documents, including a standardized first-dose patient eligibility screener, patient and nurse education material, and a competency checklist to assess nurses' proficiency.

The lack of standardized processes for administering the first dose of a parenteral medication in the community impacts patient care and results in delays in treatment, increased emergency department (ED) visits, and SPO operational challenges, resulting in a poor patient experience and negative healthcare outcomes.

Home infusion therapy can be safe and effective, improve patients' quality of life, and reduce healthcare costs (Gorski, 2020; Gorski et al, 2021). It has been identified that home infusion patients were no more likely to experience adverse reactions (Polinski et al, 2017), and one study identified that 95% of patients completed home infusion safely and experienced no adverse reactions (Viteri, 2023). Administering a medication intravenously for the first dose requires careful consideration, planning, and following best practice standards to ensure patient safety and efficacy; this includes having an established plan to respond to emergencies, such as anaphylactic reactions and ensuring clear communication between the patient and the healthcare team.

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First dose
Collaboration
Standardization
Parenteral
Home and community care