A multi-method review of home-based chemotherapy.

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes.

[Study of a pharmacy performing homecare pump rental business].

In the Japanese home care, doctors are not required to purchase their own pump; the pump can be rented from a rental company. However, the rental company cannot do a medical support. Therefore, the Yanase-pharmacy(pharmacist)performs a pump rental business, doing a medical support to patients, doctors and nurses. The contents of the medical support are: To attend the conference before the patient was leaving the hospital , To describe how to use the pump to the patient and medical staff while the patient is still in the hospital , To describe how to use the pump to the patient and medical staff when the patient is at home , To propose how to connect the infusion route to the pump .

Continuous Drug Delivery is Significantly Affected by Relative Height Changes Between Patient and Syringe Driver.

OBJECTIVE: Syringe drivers are the principle method of giving small-volume continuous infusions of important drugs to patients. Many of these drugs are critical for the maintenance of normal physiology. Anecdotal evidence abounds of severe patient instability on movement of syringe drivers during infusion. We aimed to define the variation in drug delivery seen in three syringe drivers, with changes in relative height between the syringe driver and the end of the giving set. DESIGN: Three syringe drivers (Alaris CC [Becton Dickinson], Perfusor Space [B Braun], and Synamed µSP6000 [Arcomed]) were analyzed for reliability of flow at 0.5, 1, 2, and 5 mL/h. SETTING AND SUBJECTS: This is an in vitro investigation. INTERVENTIONS: A small air bubble was introduced into the giving set, and the progression of this was documented before and after a vertical movement of the syringe driver by 25 or 50 cm upward or downward relative to the delivery port. MEASUREMENTS AND MAIN RESULTS: For all pumps, delivery was interrupted on movement of the pumps downward, and a bolus was given with movement of the pump upward. Delivery halted at lower pump speeds for longer than higher pump speeds. The maximum delivery interruption was 11.8 minutes. Boluses given on moving the pump up were calculated as the equivalent number of minutes needed to deliver the bolus volume at steady state. The maximum bolus given was equivalent to 15.8 minutes of delivery. We were unable to eliminate the effects seen by very slow, steady movement of the pumps up or down. Static height differences made no difference to delivery. CONCLUSIONS: Syringe drivers should not be moved vertically in relation to the patient. Critical drug delivery is interrupted for up to 12 minutes with relative downward movements, and significant boluses of drugs are given with relative upward movements. As far as possible, elimination of relative height movements is advised, and extreme caution is necessary if any movements are unavoidable.

Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.

OBJECTIVE: Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps. MATERIALS AND METHODS: A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas. RESULTS: We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels. CONCLUSIONS: Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.

IV DripAssist: An Innovative Way to Monitor Intravenous Infusions Away From an Outlet?

Intravenous (IV) administration of fluids and medications are a significant part of patient treatment. In austere environments, typical methods of counting drops from gravity drips or infusion pumps both have limitations such as accuracy, weight, and need for power. The DripAssist device calculates drip rates by counting drops in IV tubing drip chambers and may provide a useful patient safety monitor adjunct. The protocol was IRB approved, prospective, and designed as a pilot study involving 28 Madigan Army Medical Center Emergency Department personnel. After a brief didactic introduction to the device for clinical staff with no prior experience using the device, participants were timed setting three normal saline infusions at rates of 250 mL/h, 125 mL/h and 83 mL/h with 15gtt/mL tubing. Participants filled out a survey on perceived ease of use and utility of the device compared to pumps and manual counting. Most participants felt the DripAssist device was easy to understand and set up, but nurses and physician assistants were more likely than medics to perceive a benefit versus IV pumps or gravity drips. The DripAssist device may offer a safe, low-weight, functional tool which could improve care in a variety of resource-limited environments. However, additional studies using the device during actual field exercises would be beneficial.

Patient safety challenges in treprostinil therapy.

Treprostinil (Remodulin) is a new therapy for pulmonary hypertension. A multidisciplinary plan for safely managing the drug is described, and includes a flow chart to guide practice through high-risk issues.

The latest developments in insulin injection devices.

The next several years promise dramatic changes in the treatment of diabetes, many of which will be driven by rapidly developing technology. Today's patient with diabetes has ready access to more information about the disease and its treatment options. As a result of this increased knowledge base, insulin-treated patients have become more autonomous in the management of their diabetes and may be better prepared to participate in making informed choices regarding insulin delivery devices. As with any insulin regimen, diabetes educators are encouraged to provide ongoing patient education and follow-up to assure optimal use of these new technologies.

Fluctuations in syringe-pump infusions: association with blood pressure variations in infants.

Flow continuity of two brands of syringe pumps and four brands of syringes was studied as a possible cause of hemodynamic fluctuations observed in neonates. Cyclical fluctuations were observed in the blood pressure of 14 neonates receiving dopamine infusions by syringe pump at flow rates from 0.2 to 1 mL/hr. Atom 235 and IVAC 770 pumps and various sizes of Terumo, Becton Dickinson, Omnifix, and IVAC syringes were evaluated. Flow continuity was assessed by using a gravimetric technique. The force needed to initiate and maintain syringe plunger motion was also measured. Noncontinuous flow was encountered most commonly with Terumo syringes, which delivered boluses at regular intervals at flow rates up to 5 mL/hr. The interval was dependent on flow rate and was similar to the time between the blood pressure fluctuations observed clinically. The syringe plunger force exhibited regular fluctuations indicative of the plunger sticking, and simultaneous measurement of flow established a direct temporal relationship with boluses. The other syringes tested did not exhibit such fluctuations. No differences were found between the two syringe pumps. Syringe plunger sticking, resulting in intermittent boluses and potential blood pressure fluctuations, may occur at low flow rates and with certain syringe brands. This appeared to be the cause of hemodynamic fluctuations in neonates receiving dopamine infusions.

Pump primer: how to choose the right infusion device.

Twenty questions to help you and your selection committee pinpoint the right infusion devices for your needs.

Infusion perfusion: i.v. pumps for every need.

Infusion pumps offer many options to improve patient care. Learn the latest technology and use this guide to choose the right pumps for your units.

Removing the confusion about infusion.

There is more to infusion technology than simply connecting the "pump-du-jour" to the central line. The purpose of infusion technology, its safety products and four categories of devices-elastomeric, mechanical, gas and membrane-are discussed.

Infusion pumps.

Confluence in technologic advances in medical electronics, the availability of new intravenous pharmaceuticals, increasing sophistication of home care delivery systems and the economic motivations imposed by Diagnosis-Related Groups and capitated care payment mechanisms stimulated dramatic developments in intravenous delivery technologies, both for the hospital and the outpatient environment. Success in the use of these sophisticated drug delivery systems, however, depends on appropriate patient selection, optimal selection of a delivery alternative and careful patient monitoring for both desired therapeutic response, health delivery quality and patient safety.

General-purpose infusion pumps.

In this Guide, we provide a variety of information intended to help healthcare facilities make informed infusion pump purchasing decisions. Specifically, we present an overview of general-purpose infusion pump technology and then guide facilities through the process of defining their needs and identifying the pump capabilities and features that will help them meet those needs. We also describe the factors to consider when performing a cost analysis to help the facility determine which unit will be the most cost-effective choice. Finally, we include a comprehensive listing of infusion pump suppliers and their products, covering 70 infusion pump models sold throughout the world. After clarifying their needs, facilities can review this listing to identify models that are worthy of further consideration. For more detailed information on choosing the most appropriate model, readers can refer to our Evaluation of general-purpose infusion pumps in this issue. In that article, we test and rate 17 pump models from 6 suppliers.

Infusion devices for ambulatory use.

Automated drug delivery is now indispensable in most hospital settings. The use of ambulatory infusion therapy in patients' homes is increasing. Nurses are often responsible for acquiring infusion devices.

Patient-controlled analgesia devices.

PCA is a practical way of giving a measure of control to patients. A variety of pumps allows selection of an appropriate device for local needs. The cost of disposables should be considered when purchasing.

Infusion devices: volumetric and peristaltic pumps.

Infusion pumps are an essential part of any acute unit's equipment. But as such pumps become increasingly sophisticated, selecting the appropriate machine has become a more difficult task. Infusion pumps are expensive, and it is essential to balance the features required with the investment made.

Intravenous infusion pumps for hospital use.

Infusion pumps provide safe and accurate delivery of intravenous fluids. Accuracy can be ensured only if the devices are used correctly. Full training is required in order to gain maximum benefit from these devices.