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Quality of life (QOL) has become an increasingly popular outcome measure in healthcare during the past 20 years. Despite its growing popularity, there is no professional agreement regarding definitions, conceptual models, or instrumentation. Many patient populations have been studied, but there has been minimal investigation of health-related QOL in patients receiving homecare, especially home infusion services. This study, which used the Ferrans and Powers Cancer Index III, explored QOL in cancer patients receiving home infusion therapies for at least 30 days. Although no statistically significant improvements in QOL were identified, the study was useful in pinpointing relevant issues for future QOL investigation in homecare and home infusion.

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Even though there has been a dramatic increase in both the type and number of nursing theories, the infusion nursing specialty remains without a theoretical base. This article addresses the need for and types of infusion nursing theory. The obstacles to theory development, including the theory-practice gap in nursing, are examined in terms of their relevance to the infusion specialty. Suggestions for beginning to create a professional environment conducive to generating infusion theory and simultaneously bridging the theory-practice gap are introduced.

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Consumerism, a significant catalyst for change in healthcare, is challenging many traditional home care concepts. This article reviews the consumer-directed home care model as piloted by numerous Medicaid programs and examines its basis in current research. Additional examples of the impact of consumerism on the Medicare program as well as nontraditional, emerging services are presented.

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In 1996, the orthopedic multidisciplinary team of Columbia (MO) Regional Hospital developed and implemented a clinical pathway for total knee replacement.

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A variety of intravenous securement devices now offer alternatives to the use of gauze and tape. Home health nurses must recognize these devices and be able to choose among the available options in making product recommendations to support enhanced patient outcomes specific to infusion therapy.

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A variety of formulae have been used by home health providers to obtain consistent and accurate reporting of intravenous catheter-related infections. This article describes the most widely used statistical formulae, their advantages and disadvantages, and their relevance to the home health setting. However, because of the numerous and complex intervening variables that influence these statistical applications, epidemiological measurement in nonhospital settings remains an unresolved dilemma for most providers.

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Since 1995 several studies have addressed whether needleless intravenous systems increase patient risk of bloodstream infection (BSI). At this time, conclusive evidence is lacking and all studies point to the need for additional research. Current studies indicate that there is no evidence that needleless systems increase patient risk of BSI when the products are used correctly and in conjunction with rigorous aseptic technique. However, these studies also identify variables not directly associated with the product or device that may contribute to an increased risk of BSI to the patient.

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OBJECTIVE: To target medically ill older home care patients with symptoms of depression in order to reduce their rate of hospitalization. DESIGN: A case-control study. SETTING: A private, nonprofit home care organization, the Visiting Nurse Association of St. Louis. PARTICIPANTS: Home care patients 65 years of age and older with symptoms of depression who were participants of a Total Quality Management (TQM) intervention (n = 81) were compared with an historical control of home care patients 65 years of age and older with symptoms of depression (n = 69). INTERVENTION: Utilization of TQM principles to develop a plan including: (a) an educational seminar on depression for home care staff involved in the project; (b) letters to physicians introducing the TQM project; (c) use of the Geriatric Depression Scale (GDS) for screening; (d) recommendation to the primary physician of a home social service (SS) consultation for patients with a GDS of 10 to 14; (e) recommendation to the primary physician of three interventions for patients with a GDS > or = 15: home SS consultation + mental health (MH), or gerontological nurse (GN) consultation + antidepressant medication (a pharmacotherapeutic algorithm sent by facsimile to the primary physician upon request). OUTCOME MEASURES: Hospitalization rates of the control group compared with the TQM intervention group, the degree to which part (e) of the plan was implemented, and the effect this had on hospitalization rates. RESULTS: The TQM intervention patients had a higher mean age than the historical control patients but were not different in percent female, percent white race, percent with a caregiver in the home, functional status, and in 15 of 16 diagnostic categories. Overall, the TQM intervention group had a hospitalization rate of 23.5% (19/81) compared with a rate of 40.6% (28/69) for the historical control group (P = .024). For part (e) of the plan (56/81 patients had a GDS > or = 15), 29/56 (52%) received the recommended SS consultation, 50/56 (89%) received the recommended MH or GN consultation, and 32/56 (57%) received antidepressant medication. One type of intervention did not seem to lower hospitalization rates more than another although having received the MH or GN visits approached significance (12/50, 24%; P = .052) when compared with the control group. CONCLUSIONS: Utilization of TQM principles and the development of an intervention such as the one described here can decrease hospitalization rates for medically ill older home care patients with symptoms of depression.

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