Initiating Self-Administration of Medicines for inpatients with cystic fibrosis

2020 ◽  
Vol 105 (10) ◽  
pp. 986-990
Author(s):  
Ian M Balfour-Lynn ◽  
Khola Khan ◽  
Nimla Pentayya ◽  
Clare Pheasant ◽  
Sian Bentley ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Reporting System ◽  
Cost Savings ◽  
Parent Satisfaction ◽  
Self Administration ◽  
Nurse Satisfaction ◽  
Electronic Reporting ◽  
Cost Implications ◽  
Drug Errors

IntroductionChildren with cystic fibrosis (CF) take a multitude of therapies at home. Self-Administration of Medicines (SAM) is a scheme whereby the parent/carer and/or older child keep control of their own medicines in hospital. We initiated a scheme and assessed drug errors, cost implications, and parent and nurse satisfaction.MethodsFollowing a pilot stage, the SAM protocol was initiated and amended as necessary. Drug errors were analysed from the Datix hospital electronic reporting system. Cost analysis of use of the patents own drugs was carried out. Questionnaires were given to parents and nursing staff.ResultsIn the initial 10 months, 97 children had 159 admissions, and 60% were deemed suitable for SAM. Drug errors still occurred—33 in 5 years. Cost savings for the hospital over 1 year were £20 022 for 123 admissions. Patient/parent satisfaction was high, and all wished to partake in SAM for further admissions.ConclusionsThe scheme was a success although it took 3 years to bring to fruition. Drug errors still occurred but we were able to amend the protocol appropriately to react to these. Cost savings are an incidental benefit from use of patient’s own medication. The SAM scheme is applicable to all children with chronic disease on long term medications when they are in hospital.

scholarly journals Decreased Wait Time and Increased Satisfaction With Bedside Pancreatic Enzyme Dosing for the Inpatient Adolescent With Cystic Fibrosis: A Quality Improvement Project Comparing Enzyme Self-Administration to Nurse Administration

2021 ◽  
Vol 8 ◽  
pp. 237437352098149
Author(s):  
Brandi Middour-Oxler ◽  
Margaret Gettis ◽  
Betsy Dye
Keyword(s):  
Cystic Fibrosis ◽  
Pancreatic Enzyme ◽  
Wait Time ◽  
Self Administration ◽  
Nurse Satisfaction ◽  
Improvement Project ◽  
Hospital Unit ◽  
Pediatric Inpatient ◽  
Inpatient Adolescent ◽  
Enzyme Delivery

For children with cystic fibrosis (CF), enzymes are essential with meals to absorb nutrients and ensure adequate growth. When hospitalized, CF patients typically rely on nurse-administered medications. Recently, a pediatric hospital unit began allowing adolescents with CF enzymes at the bedside. Postimplementation, a satisfaction questionnaire was administered to participating patients and nurses measuring patient and nurse satisfaction with access to bedside enzymes versus nurse administration and overall time for enzyme delivery. The survey utilized a 5-point Likert scale. The wait time for pancreatic enzymes decreased for self-administered enzymes when compared to those that were nurse administered. All (11/11) patients and 86% (12/14) of nurses preferred the self-administration of enzymes. Hospitalized pediatric CF patients and nurses had higher levels of satisfaction with enzyme self-administration. Immediate access to enzymes in room safes impact patient autonomy, reflecting home self-care practices. Decreases in wait times optimize nutritional growth and healing while hospitalized. As a result, a new limited scope policy allowing patient-administered enzymes is now in place in the pediatric inpatient CF unit.

SELF-ADMINISTRATION OF IN-PATIENT MEDICATIONS: A PILOT STUDY IN CHILDREN WITH CYSTIC FIBROSIS

2016 ◽  
Vol 101 (9) ◽  
pp. e2.68-e2
Author(s):  
Khola Khan ◽  
Aoife Harrington ◽  
Rupinder Pannu ◽  
Sian Bentley ◽  
Sukeshi Makhecha ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Cost Saving ◽  
Cost Savings ◽  
Training Programme ◽  
Medication Administration ◽  
Assessment Process ◽  
Main Concern ◽  
Nursing Time ◽  
Self Administration ◽  
Management Board

IntroductionChildren with Cystic Fibrosis (CF) have complex medication regimens, where responsibility for administration usually lies with the parent/carer until the child is older and able to take over this role.1 On admission to hospital this role is usually undertaken by nurses, leaving patients/parents/carers feeling disempowered, and unprepared for discharge.AimsAll CF admissions to be offered the Self-Administration Of Medicines Scheme (SAM).▸ Empower patients/parents/carers with responsibility of administering their own medications▸ Reduce nursing time▸ Educate patients/parents/carers about their medications▸ Cost-saving by utilising Patients Own Medicines (PODs).MethodA policy and training programme was developed and approved by the Trust's Medicines Management Board. This provided a framework for staff to use so that they may:▸ Obtain consent▸ Evaluate and re-use PODs▸ Safely store and obtain supplies▸ Continuously negotiate accountability for administration with patient/parent/carer.The study was conducted over a 10 month period, where all families with CF admitted, were assessed for participation in SAM. The nursing teams acted as the primary assessors for SAM and any concerns were referred to the paediatric CF multidisciplinary team. To evaluate the pilot, families were given questionnaires to establish their views about the scheme. Nurses were asked to feedback if SAM decreased time for medication administration. To evaluate the associated cost-saving, data on PODs suitable for re-use was collected.Results159 children with CF were admitted to the ward, 95 (60%) were assessed to participate in the scheme and 64 (40%) of these did not join. Reasons for not joining included 32 (50%) short admissions, 13 (20%) refused, 5 (8%) patients were seriously ill and 14 (22%) had ‘other’ reasons. Those who joined the scheme received questionnaires and 31 (33%) of these were completed. All welcomed the scheme and stated that they would take part again with the main benefits cited as not needing to wait for nurses to administer medications, greater independence and the ability to maintain the same routine as home. When asked what participants would change, 16 (52%) stated nothing, 10 (32%) wanted the assessment process to allow for faster progression through the levels of SAM, 4 (13%) asked for larger medication lockers and 1 (3%) wanted better communication about new medications. 30 nursing questionnaires were completed and highlighted that nursing staff spent less time on administering medicines. Nurses also stated that medication administration was less pressurised as double-checking of doses could be performed with the participant, rather than another nurse. Their main concern was the extra documentation required for SAM. Where PODs were used for patients, the average cost saving per patient over a 3 month period was £1023.ConclusionThe pilot scheme has been well received by staff and patients/parents/carers, allowing greater engagement in the administration of medicines and cost-savings. As a result of this, the SAM scheme will be extended to the remaining patients on the ward.

Applying the Prototype Model into the Electronic Reporting System for the Elementary School Student Base on Android

2021 ◽  
Vol 2 (1) ◽  
pp. 17-21
Author(s):  
Tukino ◽  
Siti Masruroh ◽  
Daryanto Herdiana
Keyword(s):  
Elementary School ◽  
Learning Outcomes ◽  
Teaching And Learning ◽  
Reporting System ◽  
Student Assessment ◽  
Student Learning Outcomes ◽  
Assessment System ◽  
Prototype Model ◽  
Electronic Reporting ◽  
System Method

Teaching and learning is an activity that is bound by goal directed and carried out specifically to achieve that goal. Because it is very important to seek knowledge for a bright future. Supervision of students by the guardians of the students made the results of their children's achievements not improving. As well as student assessment by the teacher is still not well managed because it is still in the form of a note report. The system method used is the Prototype model. With observation and direct interviews with the student section regarding the assessment system in the school where the author researched. The results of this study are applications that can be operated on an Android Smartphone. This application can provide fast information and update automatically in obtaining information on student learning outcomes.        

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

scholarly journals Pseudomonas aeruginosa PA80 is a cystic fibrosis isolate deficient in RhlRI quorum sensing

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Syed A. K. Shifat Ahmed ◽  
Michelle Rudden ◽  
Sabrina M. Elias ◽  
Thomas J. Smyth ◽  
Roger Marchant ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Quorum Sensing ◽  
Virulence Factors ◽  
Genomic Islands ◽  
Clinical Strain ◽  
Whole Genome ◽  
Synonymous Mutations ◽  
Wide Range

AbstractPseudomonas aeruginosa uses quorum sensing (QS) to modulate the expression of several virulence factors that enable it to establish severe infections. The QS system in P. aeruginosa is complex, intricate and is dominated by two main N-acyl-homoserine lactone circuits, LasRI and RhlRI. These two QS systems work in a hierarchical fashion with LasRI at the top, directly regulating RhlRI. Together these QS circuits regulate several virulence associated genes, metabolites, and enzymes in P. aeruginosa. Paradoxically, LasR mutants are frequently isolated from chronic P. aeruginosa infections, typically among cystic fibrosis (CF) patients. This suggests P. aeruginosa can undergo significant evolutionary pathoadaptation to persist in long term chronic infections. In contrast, mutations in the RhlRI system are less common. Here, we have isolated a clinical strain of P. aeruginosa from a CF patient that has deleted the transcriptional regulator RhlR entirely. Whole genome sequencing shows the rhlR locus is deleted in PA80 alongside a few non-synonymous mutations in virulence factors including protease lasA and rhamnolipid rhlA, rhlB, rhlC. Importantly we did not observe any mutations in the LasRI QS system. PA80 does not appear to have an accumulation of mutations typically associated with several hallmark pathoadaptive genes (i.e., mexT, mucA, algR, rpoN, exsS, ampR). Whole genome comparisons show that P. aeruginosa strain PA80 is closely related to the hypervirulent Liverpool epidemic strain (LES) LESB58. PA80 also contains several genomic islands (GI’s) encoding virulence and/or resistance determinants homologous to LESB58. To further understand the effect of these mutations in PA80 QS regulatory and virulence associated genes, we compared transcriptional expression of genes and phenotypic effects with isogenic mutants in the genetic reference strain PAO1. In PAO1, we show that deletion of rhlR has a much more significant impact on the expression of a wide range of virulence associated factors rather than deletion of lasR. In PA80, no QS regulatory genes were expressed, which we attribute to the inactivation of the RhlRI QS system by deletion of rhlR and mutation of rhlI. This study demonstrates that inactivation of the LasRI system does not impact RhlRI regulated virulence factors. PA80 has bypassed the common pathoadaptive mutations observed in LasR by targeting the RhlRI system. This suggests that RhlRI is a significant target for the long-term persistence of P. aeruginosa in chronic CF patients. This raises important questions in targeting QS systems for therapeutic interventions.

scholarly journals Gene Therapy in Hemophilia: Recent Advances

2021 ◽  
Vol 22 (14) ◽  
pp. 7647
Author(s):  
E. Carlos Rodríguez-Merchán ◽  
Juan Andres De Pablo-Moreno ◽  
Antonio Liras
Keyword(s):  
Gene Therapy ◽  
Adverse Events ◽  
Factor Viii ◽  
Coagulation Factor ◽  
Cost Savings ◽  
Factor Ix ◽  
Clotting Factors ◽  
Advanced Therapies ◽  
Potential Benefits

Hemophilia is a monogenic mutational disease affecting coagulation factor VIII or factor IX genes. The palliative treatment of choice is based on the use of safe and effective recombinant clotting factors. Advanced therapies will be curative, ensuring stable and durable concentrations of the defective circulating factor. Results have so far been encouraging in terms of levels and times of expression using mainly adeno-associated vectors. However, these therapies are associated with immunogenicity and hepatotoxicity. Optimizing the vector serotypes and the transgene (variants) will boost clotting efficacy, thus increasing the viability of these protocols. It is essential that both physicians and patients be informed about the potential benefits and risks of the new therapies, and a register of gene therapy patients be kept with information of the efficacy and long-term adverse events associated with the treatments administered. In the context of hemophilia, gene therapy may result in (particularly indirect) cost savings and in a more equitable allocation of treatments. In the case of hemophilia A, further research is needed into how to effectively package the large factor VIII gene into the vector; and in the case of hemophilia B, the priority should be to optimize both the vector serotype, reducing its immunogenicity and hepatotoxicity, and the transgene, boosting its clotting efficacy so as to minimize the amount of vector administered and decrease the incidence of adverse events without compromising the efficacy of the protein expressed.

Long‐term benefits of nusinersen in a child affected by cystic fibrosis and spinal muscular atrophy type 1

2021 ◽  
Author(s):  
Giorgia Bruno ◽  
Bernadette Donnarumma ◽  
Alessia Inverardi ◽  
Paolo Buonpensiero ◽  
Angela Sepe ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Spinal Muscular Atrophy ◽  
Muscular Atrophy ◽  
Spinal Muscular Atrophy Type

scholarly journals P096 Long-term follow-up of adolescent and adult patients with cystic fibrosis: a single centre's experience

2021 ◽  
Vol 20 ◽  
pp. S68
Author(s):  
A.I. Yilmaz ◽  
G. Ünal ◽  
B.S. Kibar ◽  
P. Sevgi ◽  
O. Eĝil ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Adult Patients ◽  
Long Term Follow Up

Long‐term clinical outcome of cystic fibrosis paediatric patients presenting with meconium ileus

2020 ◽  
Vol 109 (12) ◽  
pp. 2738-2739
Author(s):  
Ioanna Loukou ◽  
Maria Moustaki ◽  
Marina Plyta ◽  
Konstantinos Douros
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Outcome ◽  
Meconium Ileus ◽  
Paediatric Patients

scholarly journals Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization

2018 ◽  
Vol 63 (7) ◽  
pp. 492-500 ◽  
Author(s):  
David Rudoler ◽  
Claire de Oliveira ◽  
Binu Jacob ◽  
Melonie Hopkins ◽  
Paul Kurdyak
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Saving ◽  
Cost Analysis ◽  
Severe Mental Illness ◽  
Inpatient Care ◽  
Cost Savings ◽  
Support Housing ◽  
High Support

Objective: The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. Method: The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. Results: The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. Conclusions: This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

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