Assessing Readiness for Self-Infusion

Before discussing self-infusion with a facility, the bleeding disorder treatment team must first assess whether the individual—who may typically self-infuse independently—is currently able to do so safely in the context of acute mental health and/or substance use concerns. This determination should be made collaboratively by the bleeding disorder treatment team, the behavioral health provider, and the person with a bleeding disorder.

From the bleeding disorder perspective, the treatment team may consider the person with a bleeding disorder’s ability to: 

• Read and understand medication labels (e.g., dosage in units or milligrams),

• Check expiration dates,

• Perform hand hygiene,

• Reconstitute or mix the medication correctly,

• Identify and respond to particulate matter or discoloration in the medication,

• Clean the infusion or injection site,

• Remove air from the syringe or tubing,

• Access a vein or subcutaneous site safely,

• Administer the medication correctly,

• Dispose of sharps and medical waste appropriately, and

• Accurately document the infusion or injection.

State Specific Information

Laws and regulations regarding self-administration of medication vary significantly by state. Some states prohibit individuals from self-administering medication in certain types of behavioral health settings, while others grant facilities the discretion to determine whether self-administration is appropriate. In several states, facilities are required to obtain written documentation verifying that an individual is capable of safely self-infusing or self-injecting their medication.

BD SUMHAC has compiled information on relevant laws and policies in the states that participated in its State Advocacy Program.
For more information about these states, [click here].

Talking Points for Facilities Regarding Self-Infusion

• "[Insert patient name] is fully competent to self-administer their medication from a bleeding disorders perspective."

• "My patient has been independent with [his/her/their] self-infusions since age [insert age] and self-administers regularly in community settings without any medical oversight."

• "I would be happy to provide a letter confirming [insert patient name]’s ability to self-administer their medication from a bleeding disorders perspective."

• "However, it will be important for your team to assess whether [insert patient name] is currently able to safely self-administer in the context of this [mental health and/or substance use] crisis. Factors to consider in this assessment include:

  • [Insert patient name]’s current mental state (e.g., psychosis, delusions, agitation);

    • Whether [he/she/they] has expressed any intent to use bleeding disorder supplies to harm self or others;

    • Demonstrated ability to engage in safe behaviors;

    • Willingness and desire to self-infuse; and

    • Whether the use of needles could be triggering in the current context."

• "If your team determines that [insert patient name] is capable of self-administering from a behavioral health perspective, the facility will need to provide staff oversight during the infusion. This is to ensure that:

  • The medication is administered exactly as directed by the bleeding disorder treatment team, and

  • Supplies are used only for their intended medical purpose."

• "I would be happy to provide more detailed information about the infusion process or send you a video so your staff can be familiar with what to expect."

• “If your team determines that [insert patient name] is not capable of self-administering from a behavioral health perspective, then we will need to identify a trained individual who is capable of administering the medication to him/her/them. I am happy to work with you to identify an appropriate individual.”

• If your facility does not currently have established policies and procedures that allow for self-administration, but you are open to permitting it, we can send you some sample language of self-administration policies for you to consider.

• Patient Self-Infusion and Medical Stability letter: Use this template to reassure the facility that the individual is stable and capable of self-infusing from a bleeding disorders perspective. You can download this file and edit it for this purpose.

• Excerpt from MASAC Document #289:This provides information about infusions for people with bleeding disorders from national bleeding disorders experts.

• Sample self-administration policy: If the facility does not have a policy permitting medication self-administration but is open to adopting one, this is a sample policy that you can offer them as a place to start.

• “How to give factor by peripheral infusion:” If the staff wants to see an example of what a peripheral infusion looks like in bleeding disorders, you can send this video from Minnesota Children’s. 

• “How to give a subcutaneous injection:” If the staff wants to see an example of what a subcutaneous injection looks like in bleeding disorders, you can send this video from Minnesota Children’s.