If an individual is not currently capable of self-administering their bleeding disorder medication—or if state regulations or facility policies prohibit self-administration—the facility may require assistance in identifying a qualified provider to administer the infusion or injection. The bleeding disorder treatment team should collaborate with the facility to identify a qualified provider to support the patient’s care.

State laws vary regarding who may perform infusions or injections in behavioral health settings. Some states require that these procedures be carried out exclusively by licensed medical professionals. Others grant facilities the discretion to determine who may safely administer medication within their care setting.

Depending on the state and facility policies, potential options for administering bleeding disorder treatment may include:

• A provider on staff at the behavioral health facility,

• A provider from a medical unit within the same healthcare system,

• A contracted provider, such as a visiting nurse,

• A provider from an external facility (e.g., a Hemophilia Treatment Center [HTC] or an emergency department [ED]), or

• A trained family member or caregiver.

• In emergency situations, individuals with bleeding disorders may need to be transported to an urgent care center or emergency department to receive their medication promptly.

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]

Some facilities may require a “single use case agreement” to permit an outside provider to administer medication onsite. If a facility initially states that its license does not allow external providers, this may be a regulatory or contractual issue worth exploring further.

As the individual progresses in treatment, they may be able to gradually resume self-infusion or injection under supervision, if the state or facility permits it. This approach helps promote independence and prepares them for safe self-management after discharge.

Talking Points for Facilities When a Patient Requires Infusion or Injection Support

"[Insert patient name] will require someone to administer [his/her/their] bleeding disorder medication during [his/her/their] stay at your facility. Maintaining the patient’s established treatment protocol is essential to ensuring bleeding disorder stability and significantly reduces the risk that mental health or substance use disorder treatment will be interrupted by a bleeding episode."

Step 1: Assess internal capacity
"Do you have someone on staff who is qualified to administer an [infusion/injection]?"

Step 2: Explore in-system options
"If not, is there a provider from a medical unit within your healthcare system who might be able to administer the medication?"

Step 3: Explore external provider options
"If no one within your facility or health system is available, would your facility permit an external provider to administer the medication onsite?"

"Do you currently have any contracts with:

• A home infusion or visiting nurse agency?

• A specialty pharmacy with staff trained to administer infusions or injections?"

Step 4: One-time/one-off administration option
"If you do not have an existing contract, would you permit one of the following to administer the medication at your facility on a one-time basis? We would be happy to help develop a single-use case agreement, if needed:

• A staff member from our Hemophilia Treatment Center (HTC)

• A home infusion nurse

• A visiting nurse

• A trained professional from a specialty pharmacy"

Step 5: Consider family/caregiver support
"Would your facility permit a trained family member or legal guardian—approved by the bleeding disorder treatment team—to administer the infusion or injection onsite?"

Final note on standard of care
"Asking a person to discontinue their bleeding disorder treatment in order to receive mental health or substance use disorder care would represent a violation of the standard of care. We are committed to working with you to find a safe and appropriate solution."

Send the following to the facility:

• Sample single use case agreement: This document provides facilities with sample language that could be incorporated into a contract with an external provider for services related to a specific patient.