On January 30 Michael Glockling, class of 1981, spoke with Washington State University (WSU) student pharmacists about home and ambulatory infusion therapy as part of the Preparing for Your Career in Pharmacy Seminar Series.
Glockling currently works with special projects for the Providence Infusion and Pharmacy Services and serves as a Pharmacist Surveyor for the Joint Commission.
Infusion therapy is when a patient receives their medications directly into a vein through either a needle or catheter. Originally, infusion therapy was conducted exclusively in a hospital setting. As time passed, developments such as smaller infusion pumps made home and ambulatory infusion therapy a possibility.
Many infusion therapies can be administered at home, eliminating the need for a hospital stay:
- Anti-microbials – the most frequent use of home infusion
- Immune globulin – to treat immune deficiency
- Nutritional components – for complete nutrition
- Hydration
- Pain medications
- Chemotherapy – on occasion
- Colony stimulating factors – to stimulate white/red blood cell counts
Glockling explained that particularly for hospice patients, home therapies mean, “patients are able to stay at home if that’s where they want to be.”
Ambulatory infusion clinics, on the other hand, serve as, “a safety net for the hospital to have a place to be able to send patients,” according to Glockling. Today’s ambulatory clinics look very different than the hospital stay a patient used to face. “It’s a lot faster than what they may be used to,” Glockling said, “[patients] can work this into their normal work routine.”
Instead of a big medical suite, patients find themselves in an office environment with added infusion therapy resources, such as a sterile compounding complex for creating the therapies and the infusion suites where patients spend their time.
“Ambulatory infusion suites are growing by leaps and bounds,” Glockling said, “they are trying to make it as comfortable as possible.” He explained that in the infusion suites patients will get their line started and wait while their medication is compounded. After that they can sit back, relax, watch a movie, check social media, or spend their time as they desire. In many cases the suites are cubicles, each with their own television and comfortable chair.
Behind the scenes an interdisciplinary care planning team involving nurses, pharmacists and dieticians all work toward a positive outcome. Medications for the infusion therapies are even compounded by pharmacists onsite in sterile compounding environments.
In the sterile compounding environments there is good lighting and everything is made of stainless steel or materials that are easily cleaned, “we don’t want crevices, we don’t want any indentation. Any indentation is a place for stasis. Even the floors are curved up to the walls to prevent crevices.” Glockling said. He explained that anywhere water could sit in stasis could grow microbes that would taint the compounding, “one of the functions of having a clean room is monitoring if we have any microbes in the hood.”
Avoiding tainted compounds is precisely the reason for thorough standards and regulations in the infusion therapy field. Glockling advised the students in attendance, “if you want to find out what pharmacy is like in an area, find out what the board of pharmacy says they’re responsible for and what their accreditation standards are.”
In part because of these standards, most of today’s infusion therapies are conducted by larger national providers while smaller regional and local/single site providers have started to fall by the wayside. “The biggest contributor has been the cost associated with sterile compounding, that has taken the smaller companies out,” said Glockling.
There are still smaller, hospital and even insurance providers however. “We’ve always looked at [insurance companies] as the entity that collects premiums, review claims, connects providers,” Glockling said. He believes this is changing through increased vertical integration. Vertical integration is when companies merge within their production or distribution path; for example, when a coffee roaster acquires a bean farm or when an insurance company becomes a provider of care. By being more involved with patient care plans, Glockling suggests insurance companies can have a better idea of overall patient health.
Vertical integration is an ongoing theme in the health care field. “Their plan is for pharmacists to be right in the middle of those changes,” Glockling said, “I’m a little envious because you’re entering into the profession at such an interesting time.”
The college coordinates this seminar series to introduce student pharmacists to career opportunities and leaders in the pharmacy profession.
The seminars are funded through the WSU CPPS Dean’s Fund for Excellence and our community partner, the Spokane Teachers Credit Union. For information on participating in the career seminar series, or to contribute to the Dean’s Fund for Excellence to help expose WSU student pharmacists to thought-leaders and industry innovators, contact the CPPS advancement office at gocougs@pharmacy.wsu.edu or 509-358-7651.
