A Renal Clinical Case Manager will ask the PD nurse to fill out the IPN prescription form once a covered benefit has been established for the therapy. The PD nurse will tell the RCCM what type, size and strength of bags the patient is currently using and together they will determine how to fit IPN in the current PD regimen.
Fluid removal should be based on the astute judgment of the RN. However, there is free fluid in the IDPN that can be calculated in the fluid removal goal. For 2-in-1 IDPN, we suggest removing 80% of the total volume. For 3-in-1 IDPN, we suggest removing 75% of the total volume.
The dextrose used is derived from a corn base. If the patient has a true IgE allergy, then dextrose formulations are contraindicated.
Renal Clinical Case Managers review various lab markers. They primarily focus on, but are not limited to, albumin, nPCR, BUN, Kt/v, CO2, potassium, phosphorus and PTH. It is very important that they review treatment time and current weight quarterly as well. Anytime there is a major change with a patient, the RCCM should be notified.
The amount of dextrose varies per patient based on his or her weight, dialysis runtime and whether or not weight gain is the goal. Patients who are not receiving a lipid formula will receive between 2–3gm/kg/min. For those who are receiving a lipid formula, they will receive 4–8mg/kg/min.
Each patient responds differently to the therapy so the response time will vary. Depending on the goal of therapy, whether it is an increase in albumin level, weight or both, we would typically like to see an increase in albumin level and/or weight after three months of therapy without a break in service.
How long a patient needs to receive IDPN/IPN depends on the severity of the malnutrition and why the malnutrition has occurred. A Renal Clinical Case Manager (RCCM) will monitor your patient’s progress closely through lab tests and other evaluations. The patient’s lab results will be reviewed at least quarterly, and more frequently if the clinician alerts the RCCM of a change in nutritional status. Typically, the goal of the IDPN therapy is to see an albumin level increase to 4.0g/dL. Once the albumin level has reached this goal, we will determine when the therapy can be discontinued. The RCCM might suggest to hold the therapy or take a “holiday” from it to see if the patient can maintain nutritional levels on his or her own. Each individual responds differently to the therapy, so the length of time therapy is administered will vary from patient to patient.
First, complete the referral form – either as a hard copy or online – and make sure to provide a signature and date, as these are required. You should also have necessary supportive documentation ready to go. These include a signed and dated prescription—including the patient’s name, birthdate, dose, drug name, drug volume, and pump volume—a Current Telemetry, insurance information, and any trial and implant notes. All of these should be faxed to 800-355-1029. Once the necessary referral information is received, the intake process, patient contact and pharmacy fulfillment require at least 72 hours, but can take as long as a few weeks depending on the insurance authorization. We typically triage information such as alarm dates, patient requests, etc.
We like to have at least 2-3 weeks prior to the patient’s alarm date to process a referral in order to ensure we have nursing availability for the upcoming refill. There are times it can take longer due to insurance verification and authorization, or difficulty connecting with patients and caregivers. However, this is not very common and can sometimes be processed quickly.
Physician’s offices can call or email their Regional Account Manager regarding referral or contact nursing team regarding any clinical questions if the patient is active. Patients can also reach us at 800-223-4376 at any time.
In most situations, the cost to the patient will be the same or lower than an office refill. Many factors will determine the actual cost, such as insurance coverage for home infusion, copay and coinsurance status, state and federal coverage dynamics. Each patient’s cost will vary based on these factors, and we can evaluate those referrals and respond with findings. Several assistance resources are also available to many patients on service with Pentec Health. Lastly, cost due to travel, time away from work, medical transport, child care expense, and intangible costs of quality of life should be considered in the overall cost-benefit analysis.
Pentec Health employs over 170 registered nurses across the country who provide intrathecal pump management services to over 6,000 patients. Since 2013, Pentec Health achieved the only ANCC-accredited Intrathecal Nurse Training program worldwide. In 2019, ANCC awarded Pentec Nursing with distinction as an Intrathecal Nurse Fellowship. In short, this means our nurses’ expertise is second to none in the industry.
Patients are still managed by their providers who will need to provide orders regarding refills and adjustments. Our nurses complete the refills or adjustments based on those orders. Pentec Health nurses and pharmacy staff strive to collaborate with the patient and the provider. Our staff is available 24/7/365 to patients and providers to answer any questions or concerns you may have.
Beyond the standard clinical safety protocols our registered nurses have received during their nursing training, and Pentec’s ANCC accredited training programs, nurses have also been given in-depth instructions on infection control procedures. Our top priority is the health and safety of our patients, associates, and customers, especially in the home and around patients. The home environment of each patient is assessed for the patient’s safety in the home.
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P : (800) 223-4376 F : (800) 355-1029
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