The COVID-19 pandemic brought challenges to the delivery of care for haematology patients on an unprecedented level. Teams faced an urgent need to restructure ‘routine’ services to allow myeloma treatments to carry on as much as possible, while also reducing the risk to this particularly vulnerable group of patients.
Susan Robb, a Haematology Nurse Specialist at University Hospitals of Derby and Burton NHS Foundation Trust, told Myeloma UK about introducing home administration of bortezomib and its benefits to myeloma patients and hospital staff.
Introducing Bortezomib treatment at home
Prior to the pandemic, we had wanted to set up a bortezomib (Velcade®) home administration programme to reduce time spent by patients in the hospital and relieve ever increasing pressures on the day unit. The COVID-19 pandemic, however, brought about the urgency to kickstart this initiative.
Thus, in 2020, we introduced the programme through three main phases:
- Determining eligible and willing patients
- Training patients to self-administer subcutaneous injections
- Expanding the service to include pharmacist prescribing
We wrote a standard operating procedure to outline who would be suitable and at what point in their treatment course. This document also defined the steps involved in home administration. We then developed a step-by-step guide to administering subcutaneous injections for patients and their carers, family, and friends.
Patients are given the option of bortezomib self-administration at the start of their treatment. It is important to ensure that patients taking this programme are fully aware of the side effects of the treatment (particularly neuropathy) and what to do if any symptoms emerge.
We joined up with the pharmacy, which now prepares and dispenses a whole treatment cycle of bortezomib for collection by the patient or their relative.
More autonomy for patients
We are always looking for ways to give autonomy and control to patients, help them plan their time better and reduce their time in the hospital.
From our patient feedback questionnaires, we were pleased to see that our desire for an improved patient experience was borne out. Patients reported that self-administration of bortezomib also helped them regain some control of their myeloma, saved them money by reducing travelling, and helped ease their anxieties about visiting the hospital so often.
Resolving initial challenges
Changes in standard practice are often bound to create ‘teething issues’. Transparent communication with patients and between departments was vital to ensure that we resolved those issues.
Being able to supply all the bortezomib needed for a full cycle has been challenging at times due to supply chain issues. Sometimes patients have had to collect treatment more than once during the cycle.
Advice for developing the service in other hospitals
Don’t be put off thinking it’s too large a challenge. Involve the pharmacy, administration, medical and nursing staff in the planning process to ensure you are utilising everyone’s skills and that the service works for every department.
Finally, ask others to share their experiences. We can learn from each other without re-inventing the wheel! We are happy to be contacted if further information regarding the process is required.
If you would like to find out more about the service at Derby, please contact the CSEP Team at firstname.lastname@example.org
Written by Susan Robb
Nurse Specialist – Haematology
University Hospitals of Derby and Burton NHS Foundation Trust