Under my skin: Preliminary outcomes of establishing a subcutaneous immunoglobulin (SCIg) program in a regional health service

Abstract

Background: Immunoglobulin replacement therapy (IRT) is standard of care for patients with primary or secondary immune deficiency. Intravenous immunoglobulin (IVIg) is the predominant form of IRT in Australia. In March 2013, subcutaneous immunoglobulin (SCIg) was approved for use in Australia by the National Blood Authority (NBA) for use in these patients. Administration of immunoglobulin by the subcutaneous route in the home environment is advantageous for both the patient and health service. It reduces patient admission episodes and adverse reactions, produces more stable blood levels and thus decreases infective episodes. The Sunshine Coast Hospital and Health Service (SCHHS) has faced a continuing challenge to provide sufficient day procedure beds for the increasing number of day infusions procedures. As patients can be trained to self-administer SCIg at home, this provided an avenue of reducing day bed requirements. Aims: To review the process and assess the early impact of implementing a patient administered SCIg Program. Methods: In September 2013, senior members of the immunology, haematology and transfusion teams discussed the possibility of implementing a SCIg program within SCHHS. Key stakeholders were identified and consultation took place in October 2013. A cost benefit analysis and a literature review were undertaken. A Briefing Note was submitted to the Patient Safety and Quality Committee and the Executive Leadership Team in December 2013 and subsequently endorsed implementing the program. Results: Rollout of SCIg program:The Transfusion Clinical Nurse Consultant co-ordinated the implementation of the SCIg program in January 2014. A Training Day was undertaken in January involving 20 key medical, nursing and laboratory staff. Representatives from SCIg product manufacturers also attended.Issues and processes required for the commencement of a SCIg program were discussed, and planning was undertaken. Issues identified included: - Availability of pumps and equipment - Clinic space for training, patient review and nursing support - Patient training (self infusion techniques, product knowledge) - Dispensing a blood product directly to a patient Patient recruitment:The first patient commenced SCIg training on the 17th March 2014.In the first 12 months, 35 adult immunology and haematology patients were recruited onto the SCIg program. Although the patient competency training program was planned to include four sessions, 25 patients (71%) gained competency in 1 to 3 sessions. 9 patients (26%) required 4 training sessions and 1 patient (3%) required 5 training sessions.In the first 12 months, approximately 455 day admissions were saved by patients enrolled in the SCIg program. Summary/Conclusion: The SCHHS was the first health service in Queensland to implement a home based SCIg program which has generated valuable day bed savings. The SCHHS SCIg program has grown to be the largest cohort of adult haematology and immunology patients in Australia.Further studies are currently underway to assess the clinical, economic and patient quality of life impacts of this program.L616935419 <br />