Parenteral Therapy Referral Form and First Dose Parenteral Medication Screener

Shared on behalf of Ontario Health atHome

Ontario Health atHome is introducing updated organization-wide clinical infusion services policies, procedures and forms aimed at promoting reliable, consistent, safe and equitable patient care across the province. Developed in partnership with primary care, nursing service providers, infusion service vendors and our staff, implementation of the new documents will occur using a phased approach, beginning in November 2025 with completion targeted for March 2026. 

A new Parenteral Therapy referral form and First Dose Parenteral Medication Screener for Adults are available to use for patients receiving home care services.

The Parenteral Therapy referral form and First Dose Parenteral Medication Screener ensure excellence in home parenteral therapy and are based on best clinical practices from the Canadian Vascular Access Association, Infusion Nurses Society and Registered Nurses Association of Ontario. 

Improvements to the referral (order) form include:

  • Exceptional Access Program (EAP): Details required for funding of certain medications.
  • Dose delay management: Field to specify actions in case of dose delays, including total duration of therapy, next dose timing, and delay instructions.
  • PICC measurements: Field to document Peripherally Inserted Central Catheter (PICC) measurements for management by community nursing, including removal of PICC if ordered.
  • Medication sensitivity: Field to identify if patient is on beta blockers or ACE inhibitors to manage potential side effects.
  • Height and weight: Required for medications needing weight-based dosing to assist pharmacy and nursing teams.
  • Medication discontinuation: Field to indicate when transitioning between medications (e.g., antibiotic changes) to ensure proper hydration and therapy management.
  • IV access protocols: Prescribers may select flush/lock protocols and authorize service providers to follow best practices for dressing changes. Reference protocol available HERE.
  • Heparin Use: Heparin is no longer the best practice and will only be provided if explicitly ordered by the prescriber.

NEXT STEPS

  • Share this memo with all internal prescribers within your organization.
  • Prescribers, please ensure all fields of the form are completed. Incomplete orders can unnecessarily delay care for patients.
  • Please use this new form when appropriate. The new Parenteral Therapy referral form can be found on the Ontario Health atHome website.
  • Ontario Health atHome will continue to accept and process ALL accurate and complete clinical infusion referral forms. 

CONTACT

For support or questions, please email: NW_Clinical_Infusion_Questions@ontariohealthathome.ca.

Thank you for your help with this important clinical work that will benefit patients, providers and staff.