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Published byPauline Riley Modified over 6 years ago
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Pilot project to introduce the delivery of high dose chemotherapy in the home setting using an ambulatory infusion device Caroline Croezen CNM II Haematology Day Ward St James Hospital, Dublin
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Background Historically high dose chemo given in the inpatient setting
Ambulatory care applies to patients who require close monitoring but are mobile and do not need to stay in hospital overnight EPOCH is used to treat patients with diffuse large B cell lymphoma Etoposide, prednisolone, vincristine, doxorubicin & cyclophosphamide Using an ambulatory device regimes such as EPOCH can be safely delivered in the home setting
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Background A multi-disciplinary approach is key to making this model a success Consultant Medication Safety Officer Liaison Nurse Business Manager CNMs from inpatient and outpatient ward Pharmacy Medical Physics A Protocol was written
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Method Met with reps from 2 different companies
1st pump CADD Legacy Pump-Smyth’s Healthcare 2nd Bodyguard Pump-Rockford Healthcare Formal training from the company for staff of the inpatient and outpatient ward Project lead ensured different staff set up the pump each day to ensure everyone had experience with pump set up and troubleshooting
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Method Complete first cycle given as inpatient to ensure no issues with alarms and charging Subsequent cycles patient attends day ward daily for assessment and pump change Staff on inpatient ward aware a patient at home on ambulatory pump If any alarms patient would have to come in from home Patients have 24 hour contact numbers and a spill kit
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Method As day patient patient must start on a Monday
Day 1 Ritux is given on day ward EPOCH pump attached and placed in backpack and patient goes home Back the next day at the same time for pump disconnection and new EPOCH bag connection Day 5 pump is removed and half hour cyclophosphamide infusion given Bloods taken twice weekly in day ward
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Agreed criteria for patient selection
Willingness and competence to undertake extra responsibilities such as charging of device every night Good level of written and spoken English Live within one hour of the hospital Must have a central venous access device insitu
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Case Study One 35 year old Polish National
Wife had just had a new baby Able to continue work in IT while on ambulatory pump Completed six cycles using the pump with no issues Currently in remission
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Case Study Two 21 year old fashion student
Suffered terribly with anticipatory nausea and vomiting Lives in Drogheda 100% reduction in anticipatory nausea, quality of life greatly improved Completed six cycles using the pump, currently in remission
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Case Study Three 40 year old gentleman
Was up all night in hospital from high dose steroids At home could watch TV until 5am without disturbing anyone Was able to go out and about during the day and do his shopping Currently in remission
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Case Study four Surgical SPR within the hospital
Didn’t want to see colleagues on ward rounds Wanted to be at home with his children Massive increase in quality of life using ambulatory pump Currently very well and in remission
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Cost Savings 5 cycles treatment, 6 bed days per cycle
(A) Actual Current Costs 5 cycles treatment, 6 bed days per cycle LOS per patient 5 x 6 = 30 days 10 patients per year: 30 x 10 = 300 days Total current cost : 300 x (1000 EURO/night) = 300,000 EURO (B) Proposed costs following business case implementation One pump: euro Giving set: 220 euro per 20 Rucksack: 175 euro One box giving set per treatment course per patient=220 Total proposed cost: (Pump + giving set + rucksack) =2,345 C) Difference (Actual Current CostS (A)- Proposed costs (B) 300,000- 2,345=297,655 EURO
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Conclusion Using ambulatory infusion pumps regimes such as EPOCH can safely be delivered in the home setting Greatly improves quality of life for patients Quality initiative for hospitals as it reduces inpatient hospital stay by at least 6 days per cycle Now standard of care-2 pumps purchased
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References Kliethermes M.A and Brown T.R. (2011) Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists. American Society of Health System Pharmacists, Bethesda. Newton, C. and Ingram, B. (2014) Ambulatory chemotherapy for teenagers and young adults. British Journal of Nursing 23 (4)
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Thank You!!!!
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