Safety and Clinical Outcomes of Hospital in the Home.

OBJECTIVES: The aim of the study was to evaluate clinical outcomes and adverse events (AEs) experienced by patients treated within the Hospital in the Home (HITH) service of a major metropolitan hospital in South Australia. METHODS: A retrospective case note audit of 100 HITH episodes among adults who received continuous intravenous antimicrobial therapy via an elastomeric or electronic infusion device was undertaken. Age- and sex-adjusted binomial logistic regression analyses were undertaken to identify factors associated with major and minor AEs. RESULTS: Of the 100 patients included, 71 were male and the mean (SD) patient age was 62.8 (17.19) years. Elastomeric infusion devices were used for 98 patients. The mean (SD) HITH treatment duration was 20.1 (11.9) days. Overall, 130 AEs were documented for 72 patients (72%), of whom 12 patients experienced a major AE and 68 patients experienced a minor AE. There were 45 occasions among 23 patients where an infusion administered through an elastomeric device did not run to completion. Fifteen patients were readmitted to hospital. Minor AEs were more likely among people with more vascular line days (adjusted odds ratio [aOR] = 1.05; 95% confidence interval (CI) = 1.01-1.10 per day increase) and females (aOR = 4.43; 95% CI = 1.14-17.17). An increased number of vascular line days was associated with an increased likelihood of an incomplete infusion (aOR = 1.05; 95% CI = 1.01-1.09). Hospital readmission was more likely with increasing age (aOR = 1.06; 95% CI = 1.01-1.11 per year increase). CONCLUSIONS: Adverse events need to be monitored carefully when HITH treatment is provided for extended periods.

Flow rate accuracy of ambulatory elastomeric and electronic infusion pumps when exposed to height and back pressures experienced during home infusion therapy.

Background: Elastomeric infusion pumps are widely used in the delivery of parenteral medications in the home, but real-life conditions may not match calibration or standardised testing conditions. This study investigated the impact of changes in infusion pump height and/or back pressure on infusion pump function. Methods: Volume delivered after one day, infusion duration, average and peak flow rates and time spent within stated accuracy were determined for four elastomeric and one electronic pump using gravimetric technique. Experiments were repeated after altering the height of the pump relative to the output (±40cm, ±20cm) and/or adding a back pressure (10-30mmHg) to the output of an attached catheter. Results: Under ideal operating conditions, the flow rate deviated from that specified by the manufacturer and between 88.5% and 99% of the total infusion volume was delivered. Varying the height or applying back pressure led to further changes in average flow rates and the volume of infusion solution delivered by the elastomeric pumps, but had little effect on the electronic pump. Conclusions: Clinicians should consider potential impact on drug delivery, safety and therapeutic effect for home infusion patients given variations in infusion pump performance observed in this study.

Evaluation of the Quality of Sterile Compounding Videos Available on the YouTube Video-sharing Website.

The objective of this study was to evaluate the quality of instructional sterile compounding videos posted on a popular video-sharing website (YouTube). YouTube was systematically searched using relevant terms (aseptic compounding, sterile compounding) to identify all videos demonstrating aseptic manipulations of compounded sterile preparations in a cleanroom. Promotional videos, news stories, interviews, and videos with manipulations performed outside a cleanroom, without audio or spoken in a language other than English, were excluded. Three experts independently reviewed each video and assessed the quality of key sterile compounding processes, information delivery, and overall suitability for workforce training using a standardized assessment tool. Kendall's coefficient of concordance (W) was calculated to assess agreement. Included were 66 videos with a median of 839 (IQR 62-3935) views. There was moderate to substantial agreement among assessors when determining the quality of each step of the compounding process (W 0.48 to 0.72; all P<0.002). Only one in five videos demonstrated an acceptable standard of gloving and garbing, while product inspection and waste disposal processes were more likely to be appropriately demonstrated. Most videos had acceptable sound/image quality and English pronunciation, but not all videos had a comprehensive narration. Six videos (9%) were recommended for training compounding personnel by two assessors and a further 17 (26%) videos were recommended by one assessor. No videos were recommended by all three assessors. The conclusions of this study are: 1) there is considerable variation in the quality of instructional sterile compounding videos available on the YouTube website; 2) few videos are suitable for training compounding personnel.

Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration of antibiotic therapy in the home: the Comparing Home Infusion Devices (CHID) study.

INTRODUCTION: Previous studies comparing satisfaction with electronic and elastomeric infusion pumps are limited, and improvements in size and usability of electronic pumps have since occurred. The Comparing Home Infusion Devices (CHID) study plans to assess patient and nurse satisfaction with an elastomeric and electronic pump for delivering intravenous antibiotic treatment in the home. Secondary objectives are to determine pump-related complications and actual antibiotic dose administered, evaluate temperature variation and compare pump operating costs. METHODS AND ANALYSIS: The CHID study will be a randomised, crossover trial. A trained research nurse will recruit patients with infectious disease aged ≥18 years and prescribed ≥8 days of continuous intravenous antibiotic therapy from the Royal Adelaide Hospital (RAH) (Adelaide, Australia). Patients will be randomised to receive treatment at home via an elastomeric (Baxter Infusor) or an electronic (ambIT Continuous) infusion pump for 4-7 days, followed by the other for a further 4-7 days. Patient satisfaction will be assessed by a 10-item survey to be completed at the end of each arm. Nurse satisfaction will be assessed by a single 24-item survey. Patient logbooks and case notes from clinic visits will be screened to identify complications. Pumps/infusion bags will be weighed to estimate the volume of solution delivered. Temperature sensors will record skin and ambient temperatures during storage and use of the pumps throughout the infusion period. Costs relating to pumps, consumables, antibiotics and servicing will be determined. Descriptive statistics will summarise study data. ETHICS AND DISSEMINATION: This study has been approved by the RAH Human Research Ethics Committee (HREC/16/RAH/133 R20160420, version 6.0, 5 September 2016). Study results will be disseminated through peer-reviewed publications and conference presentations. The CHID study will provide key insights into patient and provider satisfaction with elastomeric and electronic infusion pumps and inform future device selection. TRIAL REGISTRATION NUMBER: ACTRN12617000251325; Pre-results.