How the pandemic has changed infusion nursing

December 17, 2021

Maggie Stewart

As the pandemic continues to be in flux, having a huge impact on all aspects of life, it's clear that some changes are here to stay. It's also become clear that infusion nursing, like the rest of healthcare, may never quite be the same.

Infusion nurses have endured unprecedented trauma and loss in both their professional and personal lives. Whether working on-site or as home health nurses, many feared for their safety.

The field, meanwhile, has faced challenges, such as supply shortages and shifts in demand. These disruptions have prompted it to adapt in productive ways, according to Veronica Crawford, R.N., B.S.N., clinical support manager for McKesson Medical-Surgical.

"We've seen people feeling empowered to do things that weren't done before," Crawford says. A former infusion nurse herself, she now supports McKesson's home infusion customers.

Here are a few ways Crawford and others have seen the pandemic alter infusion nursing, possibly for the long term.

Personal protective equipment (PPE) shortages

Prior to the winter of 2020, nurses didn't necessarily think much about wearing masks, gloves and other protective gear when they saw patients. Then, all of a sudden, these supplies became essential for ambulatory and home health nurses' safety. And many not only wanted these supplies, but a lot of them.

Crawford, who helps customers plan their supply orders, remembers a flood of demand for personal protective equipment (PPE). "It wasn't just the supply person who was ordering and calling. We had administrators, CEOs and CFOs calling," she says.

To handle the demand, McKesson put PPE on allocation. This designation means customers receive limited quantities. It is intended to make sure supplies are distributed fairly and to prevent hoarding. Allocation decisions take into account factors including a customer's order history, the size of the facility and its COVID-19 positivity rate.

Surges in COVID-19 infections and troubles with the supply chain have continued to create problems with supplies, including PPE. As of early December 2021, McKesson continued to allocate certain items, which have changed over time.

"There's an ebb and flow in terms of what's the hot item now, and we're left scratching our heads a little bit," Crawford says. She expects allocation to end at some point. However, she's not sure when this may happen.

Prior to the pandemic, most customers did not have reserves of PPE or other supplies. Many ordered just enough to fit their immediate needs. Now infusion providers manage their inventory differently. Crawford encourages her customers to maintain at least a 30-day supply of PPE.

"Now we've learned a great deal about managing inventory," she says.

Prior to the pandemic, most customers did not have reserves of PPE or other supplies. Many ordered just enough to fit their immediate needs. Now infusion providers manage their inventory differently.

Better infection prevention protocols

People are almost certainly going to wear PPE for a long time to come according to Corinne Bishop, R.N., C.R.R.N, C.R.N.I, director of clinical nursing services at Omnicare, a pharmacy services provider for long-term and post-acute care facilities, who presented at McKesson's recent webinar, Changing needs & challenges home infusion nurses face in a pandemic.

"We don't want to be a mask-wearing society, but we're going to certainly advocate for our nurses to continue to wear protective equipment, not only to protect themselves but to protect the patients that we service," Bishop says during the webinar.¹

It's not just PPE that has become commonplace. Nurses, patients and many others have become much more aware of and willing to follow other practices meant to help prevent infection.

"We would tell patients, make sure you wash your hands. Make sure you use a paper towel to dry your hands. But it never really hit home," Crawford says. Now, "I've never seen so many people using hand sanitizer and appropriately coughing into their elbow."

This new awareness can help prevent the spread of other infectious diseases, such as flu, she says.

"I've never seen so many people using hand sanitizer and appropriately coughing into their elbow." — Veronica Crawford, clinical support manager for McKesson Medical-Surgical

A shift toward home care

When the pandemic began, it injected chaos into home infusion. Nervous patients delayed or canceled appointments, even to the point of putting their health at risk. Meanwhile, infections and staffing shortages meant there weren't always enough nurses.

But in spite of these difficulties, home infusion services turned out to be well-suited for the pandemic, when care shifted into the home. Hospitals contributed to this change by sending patients home to free up space for COVID-19 patients and to prevent the spread of the virus. Likewise, other medical centers, such as cancer centers, sent patients home. "Even when the pandemic ends, some [cancer] facilities anticipate that patients will prefer home-based care and ask to continue it," stated a report in Clinical Oncology News in December 2020.²

COVID-19 patients were part of the trend too. Those recovering from infection sometimes needed care at home. In addition, the FDA's authorization of monoclonal antibody therapies to treat these infections created an increase in demand for infusion, including services at home, according to Crawford.

In infusion, just like in healthcare at large, people's expectations for where they can receive care have shifted. "The pandemic allowed people to feel more comfortable in their homes, and now they know that option's available," Crawford says.

Moving back to ambulatory sites

Like other medical offices, infusion centers had to rapidly find ways to continue caring for patients while preventing the spread of COVID-19. In spring of 2020, an international survey of infusion centers serving patients with inflammatory bowel disease documented some common approaches:³

64% reduced a 120-minute infusion to ≤ 60 minutes
14% increased intervals between a patient's infusions
67% reduced the number of patients in the center
81% increased cleaning and spacing between patients
28% increased their hours of operation

Since the early days of the pandemic, some emergency measures have ended, and more patients are returning to infusion sites. As it did for home services, authorizing monoclonal antibodies drove an increase in the need for infusion centers. In March of 2021, for example, the National Governors Association recommended that its members work to establish and support infusion centers to make it easier for people to get these treatments.⁴

After much of their service shifted out of the office, home infusion providers' saw patients return to their ambulatory suites, according to Crawford. Staffing shortages have also increased the appeal of these suites. Home infusion providers have realized one nurse could see five patients in a center much faster than it would take to visit five homes, she says.

Demand continues to evolve, however. Vaccinations have decreased the need for monoclonal antibody infusions to treat COVID-19. Home services and ambulatory suites in areas with high vaccination rates are now providing this therapy less frequently, she says.

The decline in the need for these therapies is yet another sign that the pandemic is slowly waning. Crawford recently asked nurses to put a number on how normal their work now feels. They agreed it had reached about 80%. She says this response shows that they feel they now have what they needed to do their jobs and feel safe doing them.

"We don't anticipate ever being back to 100% of where we were," Crawford says. That's a good thing, because "we've learned a lot."