Home Infusion Therapy and Patient Education: Insights from my INS 2025 Presentation
The Early Days of Home Infusion: A Personal Reflection
In 1987, when I published my first article, Effective Teaching of Home IV Therapy, the home infusion therapy landscape looked quite different from today. There were no needless connectors, no prefilled syringes, and no peripherally inserted central catheters (PICCs) or midlines. We taught patients and caregivers to draw up saline and heparin from vials using needles. For vascular access, we relied on peripheral IVs, sutured subclavian or internal jugular catheters, or surgically placed tunneled catheters. That early work became the foundation for what would later become my framework, the Gorski Model for Safe Home Infusion Therapy. This model predicts that the clinical and satisfaction outcomes are impacted by 5 aspects of care (described in more detail in Gorski 2020).
Gorski Model for Safe Home Infusion Therapy (Gorski, 2020) Copyright 2020 © Lisa Gorski Consulting, LLC
Much has changed since then, but one constant remains: Patient and caregiver education is critical to safe and effective home infusion therapy. This blog post offers evidence-informed strategies to support better education outcomes in today’s complex home infusion landscape.
The Cost of Poor Education: Hazards to Patient Safety
Poorly delivered patient education can result in the patient frustration and adverse outcomes such as infection or adverse drug reactions. Some hazards identified in a
qualitative study that involved observations of patients performing antimicrobial infusions in the home setting (Keller and colleagues, 2020) included:
misleading information from the hospital
rushed instructions
different instructions by different nurses
confusing/inaccurate written instructions, unfamiliar terminology
misinterpretation of written instructions
Memorable quotes in this study illustrate confusion:
“The instruction sheet … puts more emphasis on using the antibacterial gel. I’m [wondering] why wouldn’t you just wash your hands? So I always wash my hands, and
then I use the gel also.” (p. 142)
“[The instruction manual] uses the term ‘needleless injection cap’ several times and [patient/husband] didn’t know what this was…” (p. 135)
Teaching with Empathy and Clarity: Key Strategies
When teaching home infusion, assess for barriers that may affect the patient’s or caregiver’s ability to learn, including fear or anxiety, post-hospitalization pain or fatigue, sensory deficits (such as vision or hearing loss), functional limitations (like reduced dexterity), memory or cognitive issues, and the complexity of the infusion process itself. Identifying these factors allows you to adjust your teaching approach and support safer, more effective learning. Effective strategies include:
Create a calm, unhurried, and relaxed atmosphere
Use a slower pace of teaching
Ensure a distraction-free environment with good lighting
Help the patient find a clean, organized space for setup (e.g., cleaned kitchen table)
Use plain language, avoiding jargon or vague terms
Make direct eye contact and observe for signs of confusion
Incorporate the “teach-back” and “show-me” methods to confirm understanding – remember that you are not testing the patient but rather the effectiveness of your education
Provide good-quality written instructions, but emphasize hands-on practice
Building Patient and Caregiver Independence
Patients or caregivers are considered independent when they can:
Adhere to aseptic non-touch technique (ANTT) including good hand hygiene without cues
Set up, administer the infusion and vascular access device related care confidently
Use a timer for IV push medications
Verbalize signs and symptoms of IV-related complications (e.g., difficulty flushing, redness, swelling, tenderness at the VAD site) and medication-related reactions
State how and who to contact with problems (e.g., home care agency)
Ongoing Support:
Once independent, patients generally receive weekly and as-needed visits for site care, dressing changes, and blood aspiration for laboratory studies. These should ideally coincide with infusion administration providing the opportunity to allow for an ongoing review of technique and answer any questions/concerns.
INS 2024 Standard 66: Raising the Bar for Home Infusion Education
The Infusion Nurses Society (INS) 2024 Standards of Practice (Nickel et al;, 2024) place home infusion front and center, especially in Standard 66: Home Infusion Therapy, which emphasizes the following relative to patient education:
Re-evaluate and periodically review infusion-related skills, including adherence to ANTT; identify the need for re-education
Clear role delineation: Avoid confusion by clearly defining responsibilities for patients, caregivers, nurses, and other providers.
Support learning with teach-back and consistent materials.
Prepare for lifestyle impact: Recognize how home infusion changes routines, causes stress, and shifts caregiver roles.
More guidance can also be found in Standard 39: Patient Education including:
Ensure that websites that are used/available for patient/caregiver education are reputable, usable, and accessible
Provide a bundled approach using both printed and audio/visual materials.
Consider telehealth visits to address clinical concerns, follow-up on equipment management
Final Thoughts
Effective teaching home infusion procedures is as critical as clinical competence in infusion and vascular access device (VAD) care.
Positive home infusion therapy outcomes depend on effective teaching, which requires a careful assessment of the patient’s readiness to learn, identification of potential barriers, and consideration of learning styles, and cultural factors.
Use of standardized educational tools/processes will provide consistency – but individualizing content/verbiage may be needed
Use of technology such as telehealth should be considered to supplement/support learning and providing an opportunity to evaluate and troubleshoot any problems/patient concerns about infusion.
References:
Gorski, L. Effective teaching of home IV therapy. Home Healthcare Nurse 1987; 5 (5): 10-17.
Gorski, L.A. (2020) Infusion therapy : A model for safe practice in the home setting. American Nurse Journal 15 (6).
Keller SC, Cosgrove SE, Arbaje AI, et al. It's Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks. Am J Med Qual. 2020;35(2):133-146. doi:10.1177/1062860619853345
Nickel B, Gorski L, Kleidon T, et al. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024;47(1S Suppl 1):S1-S285. doi:10.1097/NAN.0000000000000532
Welcome!
Hi - I’m Lisa Gorski and welcome to my blog! I am excited to launch this blog to share thoughts, experiences, and insights on infusion therapy, vascular access and home health/home infusion. There is so much information available these days on every subject and I wanted to add and share my own experiences and evidence-based information. Please come with me on this journey. My plan is to periodically write a blog.
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