The Future of Medication Administration

1. The Future of Medication Administration

2. Medication Administration via Depot Technology Tyler McGrath Nursing 357

3. Objectives • Describe depot technology • Describe the materials involved • Discuss how this technology works • Discuss the advantages and disadvantages • Describe the information systems • Describe the competencies of depot technology • Discuss the legal and ethical issues

4. Depot Technology • Depot is an injection • Oil or Polymer • Medication mixed • Ease of use • Subcutaneously(SubQ) or intramuscularly(IM) intramuscularinjectionsim.blogspot.com (Corporation, 2008) (Berkowitz, 2009)

5. Depot Technology • Slow, steady entry into the blood stream • Enables high concentrations with smaller amounts • Low cost • Involves minimal teaching • Being studied for pain management (Corporation, 2008) (Berkowitz, 2009)

6. Hardware Used in a Depot Injection This depends on the injection IM - 20 gauge needle, 1 to 1 ½ inch SubQ– 25 - 30 gauge needle, ½ to 5/8 inch Biodegradable polymer (Berkowitz, 2009) Unsettlingdown.wordpress.com

7. How Does This Polymer Technology Work? • The medication in injected into the body • A medication infused polymer solidifies • Medication is released over days or months • The polymers are biodegradable (Berkowitz, 2009)

8. Positives and Negatives of Depot Usage Advantages Disadvantages Discontinuation of medications early Non-compliance Limited medications • Increased compliances • Continuous therapeutic levels of medication • Clinics for administration • Quality of life • Decreased side-effects (O’ceallaigh, 2001) (David, 2001)

9. Information Systems Involved • Clinical information system • Used for the medication administration • Captured in the electronic health record (EHR) • Spread through the system Emeraldinsight.com (McGonigle, 2014)

10. Information Systems Summarized • Clinical information systems • Driven by barcoded medication • Bar codes scan into the EHR • The EHR can communicate with multiple healthcare providers • The healthcare providers are able to communicate back

11. Competencies and Skills How to draw up a medication How to use the Z-track method Assessment of an allergic reaction Via shutterstock.com aklasiccommotion.wordpress.com

12. Responsibilities of a Nurse Informaticist • Set-up of information systems • Maximum communication • Provide a record keeping system • Less medication errors • Timed administration for medications that last longer

13. Legal Issues and Ethics Removal in patients with a history of mental instability To remove or not Birth control Long term effects on reproduction “…critics have associated administering medication in this form with coercive or forced treatment.” (O'ceallaigh, 2001) Via Corevalues.com

14. Summary of the Depot

15. SEDASYS System Lindsay Keeley

16. SEDASYS System • Computerized-assisted personalized sedation device • Delivers the drug propofol • How does it work? • IV infusion • Over sedation (“SEDASYS,” 2014)

17. Parts of the SEDASYS (“Sedation,” 2014)

18. Administration • Allows non-anesthesia professionals to administer propofol • Colonoscopy • EGD • Initiating propofol sedation • Maintaining propofol sedation (“SEDASYS,” 2014), (“Sedation,” 2014)

19. Contraindications (“SEDASYS,” 2014)

20. Safety Precautions • Lockout Timers and Dosing Limits • 3-minute maintenance rate increase lockout timer • 90 second PRN dose lockout time • To reduce accidental overdose • Max initial dose of 75 mcg/kg/min • Maintenance rates increases limited by patient responsiveness (“Sedation,” 2014)

21. Safety Precautions • Responsive Oxygen Delivery • Oxygen delivered to patient’s nose and mouth • amount of oxygen is automatically adjusted • Oxygen source must be connected to device (“Sedation,” 2014)

22. Safety Precautions (“Sedation,” 2014)

23. Studies • Lower occurrences of hypoxemia • 2.5% of patients were in deeper sedations than intended • ISAP is working to prevent and decrease these occurrences (“SEDASYS,” 2014)

24. References • SEDASYS Computer-Assisted Personalized Sedation System - P080009. (2014, August 7). In U.S. Food and Drug Administration. Retrieved October 7, 2014, from http://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm353950.htm • Sedation Redefined. (2014). In Sedays. Retrieved September 16, 2014, from http://www.sedasys.com/

25. References • David, A., & Adams, C. (2001, January 1). Depot antipsychotic medication in the treatment of patients with schizophrenia: (1) Meta-review; (2) Patient and nurse attitudes. Retrieved September 18, 2014, from http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/ 0011/64658/FullReport-hta5340.pdf • Corporation, D. (2008, January 1). SABER™ Depot Injection Technology. Retrieved September 18, 2014, from http://www.durect.com/pdf/saber_brochure_20080107.pdf • O'ceallaigh, S., & Fahy, T. (2001, January 1). Psychiatric Bulletin. Retrieved September 18, 2014, from http://pb.rcpsych.org/content/25/12/481.full

26. References • Berkowitz, A., & Goddard, D. (2009). Novel Drug Delivery systems: Future Directions. Journal of NueroscienceNursing, 41(2), 115-120. (2009, April 1).