Drug Administration In Hospitals Research Articles

Social and Behavior Change Communication (SBCC) Approach in Tuberculosis Management by Terjang Foundation

The treatment of TB faces many obstacles, both from the patient’s perspective and their environment. Therefore, the presence of TB survivors in the treatment process is expected to assist TB survivors during the recovery and post-recovery stages. Many approaches can be made to deal with TB, including the social and behavior change communication (SBCC) approach. This study aims to analyze the use of SBCC by TB survivors from the Terjang Foundation in treating TB in Bandung. This study adopts a qualitative research method with a case study approach. Data collection techniques include in-depth interviews, field observations, and literature reviews. The study results show that SBCC has been implemented as follows: 1) Advocacy is carried out through meetings to seek support from the government and other stakeholders; 2) Social mobilization is carried out by involving stakeholders, including the Health Office, community elements, and TB survivors. Social mobilization is conducted through TB Day activities, seminars, and patient visits; 3) Education is carried out by explaining TB treatment to survivors and accompanying TB patients during drug administration in hospitals.

PCN145 Economic Effects of Different Administration Scheme of Pembrolizumab in Advanced or Adjuvant Melanoma

This study aimed to evaluate the economic effect of new administration management of pembrolizumab for the treatment of advanced or adjuvant melanoma in Italy. The analysis was developed considering two subsequent methodological steps: a) unit costs estimation for administration of innovative oncological drugs (drug, nurse time, physician time and preparation costs) and b) time consumption for each administration of pembrolizumab, nivolumab or ipilimumab in Italy. These data were derived from a literature review of the Italian legislation and reimbursement scheme for the Italian National Health System (NHS) while the estimated time for each administration were derived from a survey that was sent to the ten main Italian centres for the treatment of metastatic or adjuvant melanoma. Finally, the economic impact was estimated considering a standardized 1,000 patients treated with the new administration scheme with pembrolizumab every six weeks vs standard scheme administration of pembrolizumab, nivolumab and ipilimumab for a time horizon of 6 weeks. the preliminary results demonstrate that the pembrolizumab Q6W scheme could generate a cost savings of € 1.2, € 2.2 and 3.0 million for 1,000 patients if compared with pembrolizumab Q3W, nivolumab and ipilimumab respectively. On average, 40% of these cost reductions were associated with adjuvant treatment patients. The ability to reduce the admissions for drug administration in hospital due to a new therapeutic scheme of pembrolizumab, could generate and efficient management of the oncological ambulatory reducing the number of patients that have to come in hospital.

COVID-19 driven care changes in high risk patients from an outpatient to a community setting - A cross-sectional study.

To investigate patient preferences for treatment settings in the light of the current pandemic. Patients, who prior to the pandemic had attended two different outpatient clinics in a university hospital for their infusions or injections, were interviewed by telephone. The semi-structured interviews were analyzed using qualitative and quantitative methods. Out of 49 patients with either anti-inflammatory or immunoglobulin treatments (response rate: 83 %), 24 (49.0 %) switched from subcutaneous (sc) injections in the hospital to the community setting, 18 (36.7 %) from intravenous infusions (iv) in the hospital to sc administration at home and 7 (14.3 %) moved to iv at home. During the pandemic 38 (80.9 %) wanted to continue their treatment at home, but after the pandemic 22 (46.8 %) would opt to go back to the hospital. Satisfaction was high with both settings, slightly favoring drug administration in hospital. Qualitative data shows that patients while emphasizing the importance of the relationship with the healthcare team, had increased concerns about safety as a result of COVID-19. The experience during the COVID-19 pandemic has increased self-management-skills in some patients, but long-term follow-up is needed. It has repercussions for future shared decision making for patients and their healthcare teams.

A proposal to prevent omissions and delays of antiparkinsonian drug administration in hospitals.

A prospective study carried out in the Netherlands showed that the most important risk factor for motor function deterioration in Parkinson's disease (PD) during hospital admission was medication error, including both incorrect timing of levodopa administration and prescription of contraindicated antidopaminergic drugs.1 Indeed, one of the reported reasons for omitting or delaying levodopa administration has been medication unavailability on time where needed, that is, in medical wards where the patient is admitted. Skelly et al in a recent study carried out in Derby Hospital (National Parkinson Foundation Centre of Excellence for Parkinson’s Disease) report that even in a ward specially designed to treat patients with PD, with an enhanced stock of anti-PD medications, 2.5% of all doses were not administered because the drug was not available on time.2 It is likely this problem is compounded in other nonspecialized wards and especially in smaller hospitals. To counteract this problem, Parkinson's United Kingdom “Get it on time campaign,”3 among others, has suggested that all commercially available antiparkinsonian drugs should be available in all hospital wards and on time. Given the data described previously, this seems unfeasible, especially in small hospitals where having available all the anti-PD drugs would certainly result in the expiration of many of these drugs before they are used. We think a possible solution can be found in Skelly et al’s reflections: “The available stock was not used as flexibly as we had hoped: e.g. doses of modified release medications were omitted rather than a temporary switch to available standard release drugs.”2 (p. 1246) We agree and propose a therapeutic interchange protocol (Figure 1) where the unavailable PD drug is first converted to the equivalent levodopa dose according to published dose equivalency.4 Then an immediate release levodopa dose could be administered until the original drug is available. Immediate release levodopa is cheap. Thus, having it in each hospital ward is a realistic approach. Figure 1. An example of applying the proposed protocol to prevent Parkinson’s disease (PD) drug omissions. It has to be kept in mind that dose equivalencies proposed by Tomlinson et al were developed to compare dose intensities of antiparkinsonian drugs in clinical trials rather than to use them in clinical practice and were catalogued by the authors as mere approximations. Paraphrasing Magdalinou et al5: “PD medications should be regarded as important as insulin is for diabetics.” (p. 540) Using short-acting insulin instead of the patient’s chronic insulin treatment is now routine clinical practice in hospitals. Although there may be some limitations to this approach, we think changing to an equivalent dose of immediate release levodopa could help to prevent PD drug omissions and delays.

Pharmacy Qs and As: What are your feelings regarding control by pharmacy of drug administration in hospitals?

Pharmacy Qs and As: What are your feelings regarding control by pharmacy of drug administration in hospitals?

Factors affecting drug administration in hospital.

Factors affecting drug administration to 500 consecutive patients in a gynaecological ward have been investigated. Females undergoing surgery received more drugs per patient than non-operated subjects. The numbers of concurrent diseases, the ages of the patients and the lengtht of stay in hospital were associated with increased administration of drugs. The majority of drugs in regular use were administered for infections, whereas analgesics, laxatives and tranquillizers were most often given for occasional use. The majority of patients received several drugs simultaneously. The results have demonstrated that concurrent administration of many drugs is an essential part of the hospital care of patients, rendered necessary by the genuine requirements of treatment.