The Future of Medication

Administration

Medication Administration via

Depot Technology

Tyler McGrath

Nursing 357

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

Depot Technology

• Depot is an injection

• Oil or Polymer

• Medication mixed

• Ease of use

• Subcutaneously(SubQ) or intramuscularly(IM)

(Corporation, 2008) (Berkowitz, 2009) intramuscularinjectionsim.blogspot.com

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)

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

Unsettlingdown.wordpress.com

(Berkowitz, 2009)

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)

Positives and Negatives of Depot Usage

Advantages• Increased compliances

• Continuous therapeutic levels of medication

• Clinics for administration

• Quality of life

• Decreased side-effects

Disadvantages • Discontinuation of

medications early

• Non-compliance

• Limited medications

(O’ceallaigh, 2001) (David, 2001)

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)

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

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

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

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

Right

Wrong

Summary of the Depot

SEDASYS SystemLindsay Keeley

SEDASYS System

• Computerized-assisted personalized sedation device

• Delivers the drug propofol

• How does it work?• IV infusion• Over sedation

(“SEDASYS,” 2014)

Parts of the SEDASYS

Bedside Monitoring Unit

Procedure Room Unit

Display MonitorAutomated

Responsiveness Monitor Handset

(“Sedation,” 2014)

Administration

• Allows non-anesthesia professionals to administer propofol• Colonoscopy• EGD

• Initiating propofol sedation

• Maintaining propofol sedation

(“SEDASYS,” 2014), (“Sedation,” 2014)

Contraindications

Allergy to propofol

Allergy to egg products or soy products

Pregnant or lactating women

Full Stomach

(“SEDASYS,” 2014)

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)

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)

Safety Precautions

Yellow alarm

Red alarm that

takes no drug

action

Red alarm that

stops drug

delivery (“Sedation,” 2014)

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)

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/

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

References

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