How Accredo’s field nurses enable patients to receive complex therapies without leaving home

As a specialty pharmacy, Accredo dispenses medications that treat rare and complex conditions – but that’s only one of the myriad ways we assist patients. In addition to employing more than 800 specialty pharmacists who are just a phone call away, Accredo fields a team of about 600 nurses who care for patients in their homes, educating and assisting them, as well as administering infused medications that would otherwise require a trip to a hospital infusion center or a clinic. Field nurses are available to patients in all 50 U.S. states.

The Accredo field infusion nursing team provides patient education and training on medication administration, disease states, side effect management, falls reduction techniques, home safety assessments, and disaster planning, said Mary Jane Wiseman, operations senior director of nursing.  “If a medication is safe for home administration but requires a health care clinician to administer it, our nurses will provide that, staying with the patient for the duration of the infusion and assessing their vital signs throughout.

Mary Jane Wiseman, operations senior director of nursing at Accredo

“This allows patients to receive their medications where they are most comfortable,” Wiseman said. “Nurses build relationships with their patients. Over the past 10 years, our analytics have shown the patient satisfaction rate with nursing has been 96% or higher.”

Life-saving help at hand – and in the home

While the vast majority of home visits are routine, an Accredo field nurse was on hand recently when a longtime patient experienced a medical catastrophe.

In June, field nurse Jonathan Gibson was at the home of a patient who is immunosuppressed – meaning her body doesn’t make antibodies – and requires infusions every three weeks. Each infusion takes more than five hours.

Jonathan Gibson, field nurse at Accredo

That day, the patient mentioned she didn’t feel well. Gibson did a physical assessment, which included measuring her heart rate and blood pressure. When the results were all in the normal range, he started the infusion.

A bit later, the patient visited the bathroom. Within a few seconds, Gibson heard a crash. He ran to the patient and found her on the floor, not breathing and without a pulse. He immediately began CPR and urgently asked a family member to call 911.

Although the patient remained unresponsive, Gibson continued CPR until paramedics arrived. They used a defibrillator and were able to get a faint pulse, then rushed her to the emergency room. Gibson followed her to the hospital. Once she was stabilized, the doctor came out, shook Gibson’s hand, and said, “You saved her life.”

The patient received an internal defibrillator and is on the road to full recovery. “In the immediate days following this harrowing event, I had follow-up conversations with the patient’s infusion prescriber, nurses at the hospital that she was taken to, as well as colleagues within Accredo,” said Leslie Smith, the Accredo nurse manager who is Gibson’s supervisor.

Leslie Smith, nurse manager at Accredo

“During all of these conversations – without fail – everyone praised Jonathan’s heroic efforts. One nurse put it best when she said how thankful everyone at the hospital was for Jonathan and all of the Accredo nurses who infuse their patients.  She said it was a testament to the high quality of nurses Accredo has on board.”

Nurses provide a lifeline for patients with challenging therapies

Accredo dispenses numerous medications that are ready to self-administer, such as injectable biologics in a prefilled syringe. With initial training and support, patients become comfortable with the routine and can inject themselves as often as prescribed. Other medications, however, have meticulous handling requirements. These can be more daunting for patients, especially at first, but help is literally at hand.

One example is a medication used to treat pulmonary arterial hypertension (PAH), a rare disorder characterized by high blood pressure in the lungs. As the disease progresses, the heart has more and more difficulty pumping blood throughout the body. No cure exists for PAH, but medication can help manage the symptoms. 

One frequently prescribed medication for PAH requires that each daily dose be mixed in an ultra-clean environment. Even an experienced nurse needs more than 10 minutes to mix one dose. Even one missed dose can result in complications.

Field nurses work closely with patients in their home to help them learn to assemble each dose. They visit regularly until patients can mix the right dosage and work their infusion pump. The nurses also retrain patients every 3 to 6 months on how to mix and administer their therapy.

24/7 support for patients, hospital staff, and physicians

In addition to the field nurses, Accredo employs more than 100 nurses who support patients via phone with specific programs or clinical questions. They are available every day of the week, around the clock. When a PAH patient has an issue, for example, the nurse who takes the call will have access to all their records, including their drug and dosage and exactly what equipment they use. “This allows us to quickly address their issue,” Wiseman said.

And when patients do need to visit the ER, the staff – who may not be as familiar with some of the complex medications prescribed to patients – frequently call Accredo nurses and pharmacists for support.

For example, our National Customer Support Center nurses who specialize in PAH engage in an average of 8,000 interactions each month, Wiseman said, and together with our condition-based Therapeutic Resource Center (TRC) model, their support prevented more than 1,000 emergency room visits by PAH patients in 2022.