The market for elective intravenous (IV) hydration therapy has seen a dramatic increase in demand over the last few years. Established clinics and meds spas have begun offering the service, and an influx of free-standing retail IV bars and mobile services have popped up all over the country. But this explosive growth has gone mostly unchecked until recently.
New regulations out of Alabama
Earlier this summer, Alabama’s State Board of Medical Examiners (BME) pumped the brakes on the widely unregulated service of elective IV therapy according business and health care law firm Byrd Adatto. Under Alabama law, IV therapy constitutes the practice of medicine, meaning only a licensed physician, physician assistant (PA), nurse practitioner (NP), or midwife may diagnose, assess, and prescribe IV hydration therapy.
This means registered nurses, who can legally administer IV therapy, are not qualified to prescribe IV therapy and the use of “standing orders” (pre-written prescriptions that RNs can follow without consulting the provider) does not meet the legal requirements. The regulations for IV therapy vary by location, but as more states begin to follow Alabama’s lead, tighter regulations may be soon to follow.
Currently in California, the law states that IV therapy must be rendered through a medical corporation, and at least 51% of the practice must be physician-owned. Despite physician ownership, don’t be surprised if, similar to Alabama, the doctor, NP or PA must eventually prescribe treatment in California. In many places, IV therapy businesses are entirely staffed or even owned by RNs. With new state and federal regulations forthcoming, many of these businesses will potentially be out of compliance due to lack of oversight by a licensed provider.
Why is this important?
Ultimately it comes down to patient safety. IV fluids and added supplements have the potential to interact with other meds or even worsen existing medical conditions. For example, a patient with congestive heart failure (CHF) – a condition where a weak heart is already overloaded with too much fluid – should not have a seemingly harmless bag of IV fluids!
When we first discussed the idea of offering IV hydration in our office, this was one of my top concerns as a nurse practitioner. Can I order medications that can potentially be dangerous without seeing (virtually or in-person) the patient myself? I want to know their medical history, what surgeries they’ve had, what medications, supplements, and over the counter meds they take – all the details I need as a provider to determine if IV hydration is appropriate.
Because of this, I review each patient’s intake forms, verify their medical information, and conduct a brief assessment prior to treatment. For IV therapy, our patients come into the office and everything is done in person; for injections that can be self-administered, the entire visit can be conducted virtually, with live step-by-step instruction and visual confirmation of safe technique.
One size fits all?
There is no “one size fits all” for anything in medicine, even for something that may seem simple as a bag of IV fluid. Our safety-focused approach to IV hydration not only keeps us fully compliant with regulations, it allows us to provide customized care to each patient based on their individual needs. As with all medical treatment, we advise patients to do their research when seeking IV hydration therapy to ensure there is appropriate medical oversight of the business. Your health and safety, and those around you depend on it… even if the laws and regulations in your area haven’t kept up.
By Jennifer Cooper, MS, APRN, AGACNP-BC