Self-Administration of Intravenous Medications

With proper instruction from specialty infusion therapy providers, self-administration in the home setting is a feasible option for many patients and can greatly improve quality of life.

Self-administration is a viable and feasible option for patients with chronic diseases requiring administration of intravenous (IV) medications. According to Healthy People 2020, chronic diseases are the leading cause of death and disability in the United States, and in 2008 a reported 107 million Americans—almost 1 out of every 2 adults 18 years or older—has at least 1 of the 6 repor-ted chronic illnesses.¹ Barriers to health care services impact a patient’s ability to receive needed intravenous medications required to treat their chronic disease state. Lack of access to physician offices, clinics, or infusion centers (alternate sites) can lead to unmet health needs, delays in receiving appropriate care, missed doses, and hospitalizations that could have been prevented.²

A problem identified for nursing is the fact that without self-administration, the barriers to health care access and incidences of re-hospitalizations cannot be minimized. More importantly, limited access to health care services further impacts overall physical, social, and mental health, which directly impact quality of life (QOL).² Limited QOL activities can have a long-term effect on a person’s well-being. Since 1997, the National Health Interview Survey has collected data rela-ted to limitations on daily activities. In 2006, 5.5% of adults aged 18 to 44 years had a limitation of activity and 32.6% of non-institutionalized adults 65 years and older, had a limitation of activity.¹

Research conducted so far has just begun to scratch the surface of self-administration at home versus alternate site infusions and the impact on quality of life. An important research and clinical direction involves improving QOL of persons with chronic or rare diseases. This can be accomplished by understanding the relationship between self-administration and improved QOL.

A literature review (CINAL, PubMed, and EBSCO Host) was conducted and articles in peer-reviewed journals, which addressed QOL, self-administration, and rare and chronic disorders, were selected, reviewed, and summarized. There was a limited amount of information available on the subject, which emphasizes the need for research in this area. Previous studies have shown that patients who are adherent to protein-replacement therapies for other types of chronic diseases, such as factor VIII for hemophilia and intravenous immunoglobulin for patients with antibody deficiencies, have better outcomes.

Focused efforts of specialized infusion nurses provide an opportunity to educate and train patients to better manage chronic disease, which may benefit overall health and QOL.³ Several articles have cited the positive outcomes of learning self-administration as it relates to QOL measures. In the article “Replacement IgG Therapy and Self-Therapy at Home Improve the Health-Related Quality of Life in Patients with Primary Antibody Deficiencies,” the authors reported that self-administration at home improves health-related quality of life and treatment satisfaction by empowering the patient and families—facilitating being able to work or study, improve family relations, increase flexibility and sense of self-control among the patients and families, and improve their daily life situation.⁴ Factors cited as being of importance for high health-related QOL and treatment satisfaction nestled around coping abilities or how patients manage their condition and treatment.

Although this article examined health-related QOL outcomes of patients before and after treatment with IgG replacement therapy, findings also suggested that being able to self-administer at home instead of visiting the hospital increases treatment satisfaction of both adult patients and their families, resulting in increased flexibility, independence, and sense of control.⁴ Self-administration allows for greater flexibility, increased convenience, and increased QOL as well as decreasing cost associated with travel to an alternate site. Furthermore, it is associated with a low incidence of cannulation failure and may preserve veins more effectively than alternate site care.⁵

Administration of infusion therapy in the home setting is not a new concept, nor is teaching self-administration; however, the role of the specialty infusion nurse has expanded from not only teaching how to administer medication but how to obtain IV access. As the health care continuum continues to shift to include evaluation of patient-centric outcomes and utilization of health care dollars, research into the effectiveness of self-administration should be an area of focus for specialty infusion therapy providers. SPT

References:

1. General health status. Healthy people 2020 (fact sheet). Healthy people 2020 website. www.healthypeople.gov/2020/default.aspx. Published November 15, 2011.

2. Access to health services. Healthy people 2020 (fact sheet). Healthy people 2020 website. www.healthypeople.gov/2020/default.aspx. Published October 30, 2012.

3. Gregory C, Landmesser L, Corrigan L, Mariano D. Feasibility of home infusion and self-administration of nanofiltered CI esterase inhibitor for routine prophylaxis in patients with hereditary angioedema and characterization of a training and support program. 2013. Manuscript submitted for publication.

4. Gardulf A, Nicolay U. Replacement IgG therapy and self-therapy at home improve the health-related quality of life in patients with primary antibody deficiencies. Curr Opinion Allergy Clin Immunol. 2006;6(6):434-442.

5. Dagen C, Craig T. Treatment of hereditary angioedema: items that need to be addressed in practice parameter. Allergy Asthma Clin Immunol. 2010;6(11):1-7. www.aacijournal.com/content/6/1/11.

About the Authors

Virginia Strootman, RN, MS, CRNI, has been a nurse for 26 years and an infusion nurse for the last 23 years. She is currently a patient liaison with NPS Pharmaceuticals, Bedminster, New Jersey, providing advocacy for patients with rare and chronic disorders.

Cherylann Gregory, RN, BSN, is founder and president of the Specialty Pharmacy Nursing Network (SPNN) and has more than 30 years of experience as an oncology/infusion nurse. Cherylann serves on the Specialty Pharmacy Times editorial board.