Episode 11: A behind the scenes look at infusion nursing with Amy Arredondo

Dylan McCabe: WeInfuse podcast, episode number 11. Welcome to We Infuse podcast, my name is Dylan McCabe. Each week we give you a behind the scenes look at the infusion practice from a provider perspective, a patient’s perspective and from all the perspectives that we can and we also interview industry leaders and thought leaders in this space, this incredibly unique therapy that’s given to patients. In this episode in particular, we’re going to interview Amy Arredondo. She’s an infusion nurse. She fell in love with infusion nursing but the interesting thing about her is she’s really worn every hat you can wear in the infusion practice. She has been on the benefits investigation team of a practice. She has been an infusion nurse. She has been in a managerial role. She’s dealt with the administrative challenges and also the clinical challenges and of course, you’re going to hear her really, her love and her passion for patients. But the great thing about this interview is Amy’s going to give you really a behind the scenes look of what it’s like, just kind of a day in the life of an infusion nurse, but really how to have a thriving practice and not get bogged down by the administrative side of things. So without going any further into it, let’s jump right in and I’ll just let you know that when we recorded this podcast yours truly got way too close to the mic and for about the first minute and a half, so please be patient with that where you can tell it just sounds muffled, but I guarantee you that it clears up after about a minute and a half and it actually sounds normal. Amy and Bryan sound great, but I’m way too muffled. So forgive the podcast host on that one. All right, guys, let’s jump right into it. All right, guys. Thanks for joining us today and like I mentioned, we have a special guest on the show today, Amy Arredondo, she’s at the Central Texas Neurology Consultants. They have some of the leading MS Specialists in the country. Really they’re doing clinical trials, they’re really doing some cutting edge stuff there and she has been an infusion nurse for a while and has seen all kinds of things that she’s going to bring some stories and some things to the table. We also have one of the owners of WeInfuse, Mr. Bryan Johnson here today. So guys, thanks for being on the show.

Amy Arredondo: Thanks for having me.

Bryan Johnson: Thanks, Dylan.

Dylan McCabe: All right. So the reason we want to get into this as always is to take the confusion out of infusion and we like to interview people like Amy, who can tell stories and really give us a behind the scenes look at what it’s like to be in infusion from the provider’s perspective as a nurse, as a patient, all the different perspectives you can take in this kind of industry. So Amy, why don’t you just take a second and give our listeners a little bit of background on your experience so far?

Amy Arredondo: Okay. I’ve been in healthcare for over 20 years. I started out as a medical laboratory technologist, really liked working with the patients because that’s kind of what we do. Actually decided to go back to nursing school, graduated in 2001 and I’ve been a registered nurse ever since. I started out in the ER. I kind of just by happenstance, fell into infusion and found out that I really loved it. Did infusions for 10, 12 years, not only did I do the bedside nursing also did upper management. Got to deal with pretty much anything with the patients, pre-determinations, insurance inventory, getting drugs, patient advocacy. So a lot of different avenues, wore a lot of different hats. Right now I’m back into bedside nursing with the infusion. We’re doing pretty much any of the neurological drugs. We do a lot of migraine stuff, a lot of Ms stuff. We do like clinical trials. It’s great. I love infusion. It’s all about the patient for the most part. It’s not like hospital care. Not that there’s not a place for that, there is, but infusion infusion nursing is a little different. 15, 20 years ago, if you said you were an infusion nurse most people wouldn’t know what you were talking about. In fact, when I started, I didn’t know, they were like, oh yeah, you should get an infusion so I was like a what? Because I didn’t know what that meant, I do now though. It means a lot of different things

Dylan McCabe: And something that stands out to me there. I mean, you said you’ve worn a lot of different hats. You’ve been in different settings. So when you say you love and fusion, what is it that you love about it?

Amy Arredondo: I think that as a nurse, you have a big impact on the patient. Not just education and being there, but you are with that patient sometimes on a daily basis for weeks at a time. So you’re not just their nurse, your their bouncing board, their education person, they ask you questions. I mean, I spend more time with some of my patients than I do with my outside family because I’m with them so much. I mean, they see me once a week. They might see me every two weeks, every four weeks. I see them more than their doctor does. So if they have questions that I can’t answer, then I can get the answer for them. It’s about not just infusing them, but kind of their total care when it comes to why they’re seeing us. We’re kind of their first line of defense for their doctors. We can tell the doctors, hey, you know, she’s not doing that well, I know she’s seeing you every three months, but in the last two months, this, this, and this has happened to her or she’s had more falls or she feels like it’s not working. So we get to play a big part in those patients’ lives.

Dylan McCabe: That’s so good and I know it’s need because I interviewed Judy back as well, who you know also, and I asked her at the end of the podcast episode, what’s one parting piece of advice for our listeners and she said, keep infusing and I thought that, and you said you love infusion. I get to hear stories every now and then, I’m more focused at WeInfuse where a lot of times focused on optimizing the business processes and stuff like that but I love to hear the patient stories, stories how patient’s lives are changed. So before we get into all that, I know we’ve got Bryan Johnson on here as well and Brian wanted to kind of highlight some things about your experience as well, and make sure that I don’t leave anything off the list through my standard cookie cutter questions here.

Bryan Johnson: Yeah. Well, thanks Dylan. So little bit of a background. I’ve worked with Amy in a previous life in our previous infusion company, got to know her as a part time infusion nurse who quickly rose the ranks and eventually became our director of nursing. So I’ve kind of watched Amy grow from nursing. She was a great nurse when she came to us and she was an amazing nurse when she left but I know that you have a long experience with infusion drugs and so I kind of wanted our audience, I really wanted to highlight the importance that I know personally, maybe your audience doesn’t know of the infusion nurse in that patient’s outcomes of their treatment. You mentioned earlier, you have a very close relationship with your patients, you see them a lot, you hear from them more. So I’d love to hear you speak more about how that relationship with the infusion nurse and the patient actually contributes to the positive outcomes of their care.

Amy Arredondo: Well, it definitely has an impact on their lives because they have someone that they can talk to. They have my ear for anywhere from an hour to two hours at a time. So if they’re there and there’s a lot of pressure when you’re at a doctor’s office, hey, do you have any questions? And you literally have like no time to tell them, because you don’t have enough time to think about what questions you have, unless you have them written down and most people don’t do that. So they sit there and they talked to me about things that have gone on and I’ve seen people come in and they’re like, I’m just not, this isn’t working, I need something else and we talked to them, we talked to the doctor, they get together, we come up with a better treatment plan or they’ll change medications that doesn’t happen very often that they change it a whole regimen, because, you know it’s kind of hard to do that and you don’t want to just change on a whim. So they’ll discuss different medications or different physical therapy, whatever it is, getting them a walker. I mean, sometimes it’s as simple as that I’m tripping, my foot drop is causing me problems. I can’t even walk to the bathroom and it’s just about getting their insurance to pay for the walker so that they can walk without falling. I mean, it’s that simple sometimes, sometimes it’s a little more complex, they come in, we say, what’s changed since your last visit? And they say, well I’m having blurred vision and I’m having this. I’m like, you know what, before we do anything today, I need to talk to your doctor. So we do kind of a mini consult, talk to them, find out what’s going on when it started, has this ever happened before? If any of those are red flags for us, we won’t infuse them. We’d go talk to the doctor. Maybe that patient needs to have a new MRI, maybe the medication isn’t working and that they need to talk about other options for them because not every drug works for every patient and not every patient can be on certain drugs just because of their lifestyle. So it’s kind of like Tetris, you got to put all the pieces together in the right order for it to work and that’s the nurse, the patient, sometimes the husband or the spouse and the doctor to figure out what is working best for them. We have some patients that do great for months and years at a time and then something changes and we don’t know what that is, that changed, but then they start going downhill or they don’t feel like it’s working anymore and that’s when you have that discussion, what do you think we need to do? Or what do you want to do? Sometimes patients are well versed, a lot of my patients are very well versed in their disease, what to look forward to, what’s going to happen to them and they’ll come in and say, hey, I heard about these clinical trials. I want to be in that clinical trial and that opens up a whole other door for the physician and the patient to discuss.

Bryan Johnson: So I’m hearing; Dylan, correct me if I’m wrong here an educator, advocate, friend, counselor, a liaison between the physicians.

Amy Arredondo: All those hats.

Bryan Johnson: All those hats, a lot more than nursing, I didn’t hear anything about sticking with needles or mixing medications.

Amy Arredondo: Well, there is that but that goes without saying, but it is a big part. We have patients who come in who are deathly afraid of needles and so you have to alleviate that or I work with a really great nurse and we distract patients. We have different things to get them focused on something other than their arm, like she’ll take their vitals and start talking to them while I get her prepared and it deflects them. I mean, it totally distracts them from what I’m doing and they’re like, oh, it’s done.

Dylan McCabe: That’s awesome. And what I hear, just like I heard through Judy, and I’ve heard from other nurses having other nurses on the show, you really care about the people and it’s about making a connection. It’s about helping somebody is about being involved in their life, in such a way that they get their freedom back, they get a lifestyle that’s worth fighting for, worth having and that’s what stands out as you share all that stuff. I just think that’s just great. So well, let me ask you this with your background and the different experiences you’ve had, the different places you’ve worked, what would you say is one of the biggest challenges that you’ve seen in the infusion world?

Amy Arredondo: I would have to say that insurance, there is no cut and dried way to get someone approved for a medication. It’s not easy sometimes, sometimes we can get somebody approved in three days. That is great, that’s perfect, that’s what we want. Sometimes we fight to get them approved. Some insurances require that you do step therapy or try other medications, orals, injectables before you go straight to IV. It just depends on the insurance and the drug, some require prior authorization. Some of them require insurance referrals. I mean, it’s crazy the things that some people have to go through to get medication that is going to make their quality of life better. They sometimes will fight for weeks on end to get a drug that literally in six months they can walk without their walker, or they’re not having to have someone else drive them now. So that is my biggest frustration, all of the red tape, as you could call it on how to get a patient a medication that they need, and it’s not necessarily the insurance, it’s somebody reading, did you do this? Did you do this? Did you did this? And if all the check marks aren’t there, they deny it and then you start all over with an appeal, a peer to peer, a predetermination, a prior authorization that is like, I mean, some of the times it’s like four pages that you’re filling out.

Bryan Johnson: Amy, I don’t want to interrupt you but if our audience make, I’m guessing some of the nurses in our audience, especially wondering why you’re a nurse, why are you talking about insurance? What is your role in that process and why are you involved in it? I’m not sure all of our audience understands the role of the infusion nurse in the insurance process because that would typically be a biller or somebody else. I mean, why are these things in your bucket?

Amy Arredondo: Because it’s not something that someone who doesn’t have clinical experience can answer, the questions that they have you have to dig through the chart, the H and Ps, which is history and physical of the patient, you have to look at the MRIs, because some of them are required, how many lesions? Well, if it’s this many lesions, we can do this. I mean, it’s not something that I lay person or someone who doesn’t have a clinical background could do. Now I’m not saying that you can’t learn to do it, they could, but we, where I work and places that I’ve been before, normally it’s a clinical person that’s doing it.

Dylan McCabe: Yeah. And that’s what we see on a weekly basis. I mean, I talked to one, two on a super busy day, sometimes three practices a day from all over the US and that’s the challenge is you have people that are clinically trained, their passion is taking care of other people and then you have to, like you said, you have to go through all this red tape and of course that’s what WeInfuse was created for which I’m going to totally plug at the end. So thank you for setting me up. But yeah, I mean, that’s the challenge is, you want to just take care of people, but there’s all these things you have to go through just to take care of a patient.

Amy Arredondo: Yeah. It’s not just bedside nursing anymore and going to nursing school, they don’t teach you all of those things. I’ve had to learn those with Bryan and Judy and Reece at my side, because it’s not something that is taught, it’s learned on the job and I learned something new prevalent pretty much every month in regards to what insurances allow, what they require. Some of our patients have to do specialty pharmacy because specialty pharmacy benefits are required and we can’t buy and bill and so that’s a whole other story.

Bryan Johnson: Yeah. Yeah. That’s a good segue. I just have one other thing I wanted to make sure we got in this podcast, Amy. Again, our audience is, it could be a lot of people, manufacturers, business people, physicians, but our audience is also nurses. So you’ve covered some of that but to the nurses in the audience who are maybe considering infusion nursing, what would you say to them in terms of, what do you think makes a good infusion nurse or someone who’d be successful in infusion nursing?

Amy Arredondo: Number one is you have to be a really good stick.

Dylan McCabe: Yeah. Judy mentioned that too on the podcast.

Amy Arredondo: You have to be a really good stick. Now, if you’re really good at sticking you like doing IVs, which I do, beyond that, I would say you have to be really good at details and you have to like paperwork, which is not a common thing among nurses. We like to be able to chart and we’re done. I don’t mind doing it because it’s a means to an end for my patients. I think any nurse who is worth their salt, if they like taking care of patients, aren’t going to mind the paperwork in the end.

Dylan McCabe: Right. And again, thank you for letting me up too if you don’t want a ton of paperwork, you can use We Infuse, but I don’t want to belabor the point. So with what you’ve experienced there, I mean, what’s one nugget of wisdom you would want our listeners to hear, especially for nurses that you would want them to take from that experience?

Amy Arredondo: If you like nursing and you like taking care of patients, infusion nursing is the way to go; it is very rewarding. Again, I said that it’s like, you have a whole other family. I mean, I have patients bring us stuff. They hear me and Molly, which is my cohort in crime at work and Kathy, we talk about stuff and one of my nurses has a penchant for caramels. The patient heard and brought us a big bag of caramels. I mean, it is like a second family. I mean, I come in every morning and I look forward to going to work because I’m going to see 30 new faces a day, but they’re not new to me, they’re just new for that day and I mean, literally, it’s like a party in our infusion center every day.

Bryan Johnson: It will. I mean, if you think about it, you’re probably spending more time with some of these people than many family or friends in a world of Facebook and streaming video and FaceTime and television and all that stuff. I mean, this is the element that’s missing for many of our lives, it’s just that one on one connection, that’s just great.

Amy Arredondo: I mean you learn about their family, their friends, their kids, deaths, marriage, births, it’s crazy.

Dylan McCabe: I’m sure. Well, let’s switch gears here with with you’ve experienced so far, we focused on the challenges, what’s a light bulb moment that you’ve had maybe at some point to where there was just an idea or a thought or an experience that really stuck out to you that let you know this is where I’m supposed to be?

Amy Arredondo: I don’t know that there was ever one light bulb moment. I think that anytime you start a new career, job, whatever it takes three months to say, okay, I think I got it, six months to go I have it and a year to know if you love it. I would say that in the first year I was like, I love it. I mean, this is what I like to talk, you probably wouldn’t figure that out, but I like to talk. I’m a very social person and it’s right up my alley because I get to talk to patients. I mean, I use that as a distraction technique, but I learned a lot about them. I learned about their trials and tribulations of their lives and people who have MS and different diseases in CIDP and I have honestly probably grown as a nurse in just picking up on things on patients. A patient can walk into my infusion center and I can tell that they’re not having a good day just because of my experience with those patients.

Dylan McCabe: Yeah. That’s so good. I mean, it really is. It’s just great to hear the patient focused mentality here. A lot of times when we talk to practices, a lot of times it’s maybe the provider or the office manager or whatever, but a lot of it’s about the numbers and about the processes. So I’m loving this, just hearing about the patient focused aspect of everything really. So, well tell us about, I mean now, today, especially being where you are now, what are you most excited about right now in infusion?

Amy Arredondo: I think I’m probably most excited about the drugs that are coming down the pipeline for infusion. I know there’s a lot of clinical trials out there. There are different things, Alzheimer’s ALS drug just came out. We have a new Ocrevus it’s been out for about a year. I really think that with each new drug we’re getting that much closer to really hitting the disease process. I mean, each step, I mean, I’ve been in it for over 15 years and each drug has just one more step for that patient to have a better, quality of life.

Dylan McCabe: That’s awesome and Bryan, was that something you wanted to kind of dig in about a little bit as well?

Bryan Johnson: Yeah, of course I know Amy, I’ve watched her career here over the last 10 years or so, and probably longer and we’re getting old. But I know you’ve seen a lot of drug launches over the years, not just in neurology, but in rheumatology gastroenterology, I even seen it in antibiotics. So just talk about, I’d like to hear, I think you’ve kind of expounded already about the evolution of infusion just in general as a service. So I didn’t know if you could speak to that a little bit for our audience.

Amy Arredondo: About launches of different medications?

Bryan Johnson: Yeah. Just your experience of watching a few and the first day you started as an infusion nurse to today and just all you’ve seen, just talk about how much has changed.

Amy Arredondo: We’ve gotten more obviously, we’ve gotten more and more each year. I will say some of them have been really good launches and some of them have not been so good launches. Most of the drugs out there have different types of assistance programs a manufacturer does. So that helps a lot with patients who have a really large balance or copay deductible. I would say that most of the recent launches have been really good with drugs. We’re able to get the drug, patients are educated, physicians are educated about the drug, a lot of good information in the clinical studies that they give you. I’m not really sure what exactly you wanted in that.

Bryan Johnson: Well, I’m setting you up for a shameless set up question here and it says the WeInfuse podcasts, everybody stand by for a plug from Dylan I hope if he’s a decent sales guy, which he is by the way and a great person; I would want to just kind of set you up or what is the importance or talk about the importance of having good systems in your role in terms of helping you get through your day as a nurse and you got to take care of the patient, but that’s not all you do as an infusion nurse is take care of the patient. I know you have other responsibilities in order to effect getting that claim with the insurance company, getting the drug into the facility, scheduling patients. So if you just talk to the importance of those systems or the lack of importance, if you want to.

Amy Arredondo: No, those are actually very important systems and you want to have a good avenue in place to make sure that when a patient’s in your chair, you have the drug that you need. You don’t want to have a patient call and say, I’m coming tomorrow and you don’t have that medication on the shelf, it’s a big deal. So the system that you have in place is important because it tracks your inventory which at the end of the month you don’t want to be looking for a $10,000 vile that’s gone missing. You want to be able to trace it back to what day you use it and the patient always used on. Not only for billing purposes, but God forbid there ever be a recall, you want to know who you gave that medication to. So the system, the scheduling, the inventory, how you do your authorizations and verification with insurance is all important. Miss one part of that, and you’re in the hole that may take you six months to a year to recover from because that’s a lost vile, it’s done, you’re 10, $20,000 in the hole already. So it’s very important that you keep track of everything that you’re doing and how you’re doing it, not just with your insurance information but your inventory. When did you get the vial? Are you rotating your stock? So all of that plays a big part in what we do. Some people have manual systems, some have Excel spreadsheets. Some people have a system that does everything from scheduling the patient, to verifications, to authorizations, to inventory and it’s all inclusive and it tags each other in their system. Some people have several systems that make up that practice. So it just depends on where you are. It’s nice if they talk to each other, communication is good.

Dylan McCabe: Yeah, absolutely. It is a multifaceted system and I mean, I know, especially for providers listening to this, they’re probably understanding a little better what the nurses go through and for other nurses listening this that are thinking about infusion you have to be a nurse and you kind of have to be a project manager too, and you have to work with the billing team or the intake or whoever it is and there are a lot of moving parts, a lot of balls being juggled in the air, so that’s really great and we really appreciate you being on the podcast and sharing your story and sharing the things you’ve learned. So with the things that you’ve learned, I mean, we could go on and talk about this for hours, but what’s one parting piece of advice you would have for our listeners when it comes to the infusion suite?

Amy Arredondo: Well, I would have to say that it’s infusion in general. I love it, it’s a great environment in most infusion centers. I mean, I haven’t been to one that the patient wasn’t the sole focus and for me as a nurse, because that’s what we do, it’s the whole picture it’s taking care of that patient and you do what you have to do it, it’s not, that’s not my job, it is your job because your job is to get that patient in the chair and give them the drugs that they need. So I would have to say that is probably the best thing that I’ve learned in this particular job. Not that it’s not always in every nursing, but it’s much more focused in office based infusion centers or suites like that and not necessarily in the hospital because it is about the patient. It’s always about the patient.

Dylan McCabe: All right. So that wraps up our interview with Amy. I’m sure you guys got a lot of value from that and if you haven’t done so already be sure to check out our website, weinfuse.com, you can get a lot of great insights from our blog that are written by Bryan Johnson, Reece Norris, really, these guys are experts. They’ve been in the business for a long time, and they’ve seen every challenge that you can deal with and overcome those challenges and if you haven’t done so already be sure to request a demo for our software the We Infuse platform, which is really an infusion management platform, so that you can manage every part of your practice and not get bogged down by the administrative side of things, but have a thriving practice and have a very simplified, streamlined process with a lot of safety checks and balances in there to make sure you that you never lose track of where you are with a patient in the process, whether it’s an auth getting approved or a calendar issue or an inventory management issue, you’ll be so glad you did just check us out weinfuse.com. All right, guys, this is Dylan McCabe with the We Infuse podcast and I will catch you in the next episode.

Guest Speaker: Amy Arredondo, RN, CRNI is a former member of the Board of Directors at the National Infusion Center Association (NICA), and current Travel RN at Healix Infusion Therapy. As a registered nurse since 2001, Amy has over 15 years of infusion experience, with focuses on gastroenterology and neurology.