The South African healthcare system is very focused around the hospital. So, admissions to hospital in many instances are deemed to represent very high quality of care. The design of medical scheme options which provides for a Hospital Plan, also determines the setting recommended for a patient who is sick – you select the setting which you are insured for. But many people who get sick do not have the privilege of medical scheme funding and therefore need to seek healthcare that is both accessible and affordable. The reality is that sometimes it is necessary to continue with hospitalisation when the clinical condition has improved significantly to the extent that the patient could technically be discharged. The hospital stay is continued and necessitated however, although the patient is already much better, because a course of medication that is given intravenously, meaning through a drip mostly in the arm, has not been completed.
This scenario has now changed, and consideration is given to alternatives to hospitalisation, and it is now realistic to allow patients of all ages to be discharged earlier from the hospital and to continue with treatment through an intravenous drip in the comfort of their own homes. It is even possible in certain cases that treatment through an intravenous drip could be started and continued at home in the first place to avoid hospitalisation altogether. This is new thinking on how to manage a sick patient and includes the alternative of the home as place of healing.
The challenge is obviously to select very carefully the patients that are the ideal candidates for treatment through an intravenous drip at home. As already mentioned, hospitalisation may initially be necessary, but a patient can be discharged earlier and continue the healing process at home.
The medical conditions that can be treated through a drip at home includes when a person is dehydrated because of vomiting or diarrhoea or even severe vomiting in pregnancy, certain infections like pneumonia or severe kidney infections where antibiotics are administered via a drip, pain relieving medication for severe pain conditions including pain after operations or pain associated with cancer, and where parenteral nutrition is needed, which means providing the nutritional substances needed through a drip when illness prevents the absorption of food in the gut.
Worldwide studies have shown that intravenous drip therapy received at home is safe and can be administered with no more side effects than when given in a hospital, that the outcomes that the medical team want to achieve is as good as in the hospital setting and that the satisfaction of patients treated in the home environment is high.
In South Africa the concept of creating a “hospital at home” is finding traction fast and intravenous drip treatment is already being administered frequently at home. These services at home are delivered by certain home healthcare organisations who specialises in creating and providing the hospital at home. The most crucial component of delivering the services at home is the development of a care plan which is done by a Care Manager at these organisations. The Care Plan is responsible for the planning and coordination of the drip treatment and includes how frequently the Nurse must visit the patient at home, the infusion administration and the assessment and monitoring parameters that are required. This Care Plan that is developed is done with the input from patients and their families, the treating doctor, whether a family doctor or specialist, the staff at the hospital to coordinate discharge and continuation of treatment at home as well as the qualified home healthcare services and medical scheme where appropriate.
Of high importance is that the intravenous infusion services to patients are always delivered in collaboration with the treating doctor IF the condition of the patient supports the viability of this option. Services are always provided with the best interest of every patient and the interest of the patient’s family in consideration and striving to achieve the best health outcomes. To be able to do so, these home healthcare service organisations invest in selecting specialised registered nurses who are specially trained for, and experienced and competent in, managing infusions in the hospital setting. These organisations also deliver the infusion services according to work policies and procedures that are accepted and published as best practices. This means that a drip is set up under sterile conditions and with processes that ensure the right fluid and medication is administered while being monitored.
To then answer the question “is a drip at my home safe” is a profound yes. Good outcomes are achieved, in the comfort of the patient’s familiar surroundings at home which can also do wonders as place of healing. It also lowers the total cost of treatment significantly and provides access to essential care that may otherwise not have been possible.
Dr. Martin de Villiers is the Medical Director at Medwell SA – The Home Health Care Specialists. Various services and options are available, for more information visit www.medwell.co.za
