Intravenous diuretic administration in the home environment
Chronic heart failure is a condition associated with ageing, affecting 1–2% of the adult population, raising to 70% of the adult population over 70 years of age. Diuretics are often the first-line treatment for patients with symptomatic heart failure, not just oedema. Traditionally, intravenous (IV) diuretic therapy has been administered only in hospitals. In 2012, the British Heart Foundation ran a pilot study investigating the effectiveness of IV diuretic administration within the home. Since then, there has been an increase in these services. This article examines the advantages and disadvantages of this service, whether community nurses are best placed to deliver this, and what the benefits to the patient might be.
In 2012, the British Heart Foundation (BHF) announced a pilot study to evaluate giving IV diuretics in the patient's home. It claimed that it would end weeks of hospital in-patient care for people with severe heart failure and could be rolled out across the UK if successful (BHF, 2012). We are now beginning to see this being provided for patients in the community, but it is not without its challenges.
For more than a decade, the Department of Health and Social Care has championed a policy of moving services from the hospital environment into the community setting, closer to where patients live (Barton, 2018). In 2017, the National Institute for Cardiovascular Outcomes Research (NICOR) called for improved and earlier detection and management of oedema in the community, to prevent the need for hospital admission (NICOR, 2017). Providing IV diuretics in the home environment meets both of these objectives, but there are far more benefits to this than mere compliance with these two polices.
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