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Is chemo in the home a “pink batts disaster” in the making?

There are few of us who escaped the news coverage of what happened when the Australian government wanted to boost the economy back in 2009, by funding the installation of “pink batts” into homes.

Tragically, four young men died, from what was found to be a lack of oversight by the government resulting in massive system failures.  Simply put, the government provided the money, but did not ensure that there was the appropriate legislation, regulation or training available to make it safe.  And where there is money to be made, there will always be some who will want to profit from it.  Some of these people will have no regard for the safety of the product they are supplying, some will be ignorant of what is needed to make it safe.  The result is the same.

When people ask me, “is giving chemo in the home safe?”, I find it difficult to answer.  To be honest the answer is both yes and no.

I have worked managing a “home chemo” service for just under 20 years.  I’ve developed a robust set of systems and process to treat cancer and chronic disease patients, who are receiving some of the most complex and risky chemotherapy and immunotherapy treatments, safely, in the home.  Arguably, I am the most experienced health care professional, and chemo@home is the largest, most skilled and experienced health care service in Australia delivering this type of service.

Over the last 12 months, numbers of other businesses have put their hands up to say, “we can do chemo in the home too”.  After the Medibank Private ads, featuring chemo@home and our patient Liam, the number of business who came out of the woodwork saying they can do this reached fever pitch.

So, if chemo@home can do it safely, can’t everyone?

No.

Let me explain why.

Most people, I think, would be shocked to know that to provide a home health service you do not need to be licensed or accredited. Licensing of health services is done at a state government level, and in each state, the health departments license hospitals, but not “home hospitals”.  This means there is no state government oversight of the home healthcare industry anywhere in Australia.  Accreditation, which is a process that ensures national healthcare standards are in place, is also not required for home healthcare services.

Giving chemotherapy and immunotherapy medications in the home requires not only an in-depth knowledge of all the national and international guidelines around the safe prescribing, dispensing and administration of these highly specialised medications, but the skill and experience to implement the same.

I was speaking with a researcher recently who was involved in a trial giving an immunotherapy medication at home.  The nursing staff administering the medication in the home did not carry with them any resuscitation equipment.  No adrenaline. No defibrillator.  Two of the most important things needed if a patient’s heart stops. When I asked why, the answer was, “there is less than a 1% chance of a reaction, so it wasn’t deemed necessary”. I then asked, “so how many infusions did you given in the trial?”  The answer was, “120”.  120 infusions, 1% reaction rate. So, this begs the question, what happened to the one patient?

The reality is portable “pocket-sized” defibrillators are expensive.  Adrenaline is expensive and has a short expiry.  Having a protocol to use both takes expert input on resuscitation procedures.  Being competent in using the protocol requires the nursing team to be trained and skilled. As a health service provider, you can either put patient safety first and invest in these aspects of care, or not.  chemo@home is committed to providing the safest environment possible and will not compromise the safety of our patients because the alternative is easier of cheaper.

Additionally, to my knowledge, there have been five major chemotherapy errors in Australian Hospitals over the last 10 or so years. By major I mean that there was a breakdown in the system which lead to multiple patients in the hospital being given the wrong dose of a chemotherapy medication.  In each of these situations a review of the errors pointed to a lack of “governance”, over how chemotherapy protocols were managed as being the major reason these occured.
 
chemo@home has robust processes around how we chose which chemotherapy and immunotherapy treatments we give at home, and how we administer these to make it as safe as possible.  Currently, we give around 140 different chemotherapy and immunotherapy regimens at home, and we continually improve our processes if, or when, problems arise.  We pride ourselves on having one of the most advanced cancer management systems in Australia.

The government is very keen to develop the home healthcare market as it is a more sustainable way of delivering care.

Private Health Insurers are keen to have home healthcare as part of their offering, to give their members choice.

Hospitals are now seeing it as a way to cope with the increasing numbers of patients that are putting their day-units and wards under presssure.

Patients and their families want treatment at home as is it is a kinder, more convenient and comfortable way to receive care.

It is clearly the way of the future.

But without appropriate regulation and legislation in place, is it really safe for patients to have their chemotherapy and immunotherapy treatments at home?  The answer is, unless they are receiving their home healthcare from an experienced, reputable, accredited service like chemo@home, maybe not.
   
Federal and state government need to step up and plug the gaps in the regulations and legislation.  Private health insurers and hospitals need to be very careful who they contract with.  Patients need to be aware that not all healthcare services provide care to the same standard.

The last thing we want is for home chemo to become the next “pink batts disaster”.  The patients are relying on us to keep them safe.  We have a duty to do so.

Julie

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