Patient Competency to Self-Administer Infusions or Injections

IF THE FACILITY IS CONCERNED ABOUT

Behavioral health and substance use disorder facilities may have limited or no prior experience working with individuals who self-infuse clotting factor or self-inject other medications. In these situations, education and reassurance from the bleeding disorder treatment team may be necessary to support the facility’s understanding and confidence in the process.

Important 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].

  • 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.

Addressing the Facility:

  • 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.”