Teaching home administration of sub-cutaneous methotrexate

Successful implementation of a nurse-led teaching programme to independently administer subcutaneous methotrexate in the community setting to children with Crohn's disease

BACKGROUND

Methotrexate is increasingly used as a third line immunosuppression agent in children with Crohn's disease (CD). Methotrexate is traditionally administered in the hospital setting.

AIM

To set up a nurse-led education programme to teach children/their parents to administer subcutaneous methotrexate in the community.

METHODS

All patients were given methotrexate over a 16-month period. Patient demographics including previous treatments were collected. A competency based teaching package was implemented by the inflammatory bowel disease nurse. Distances and travel times together with costings were calculated.

RESULTS

Thirty two patients (19 male; 13 female) with a median treatment age of 11.96 years (IQR 10.67-13.92) were studied. Thirty of 32 (17 children, 13 parents) were independently administering methotrexate. The median return journey distance to hospital was 23 miles (IQR 14.4-42.4) taking a median time of 52 min (IQR 41.0-73.5) for each injection. The total patient travel saving was £10,537 (average £730 per patient) and nursing time saving was £12,808 with home administration (total saving £23,345).

CONCLUSIONS

This paediatric study demonstrates that methotrexate injections can be given successfully in the majority (94%) of patients with CD independently in the community, resulting in significant time and money savings for patients and health professionals alike.

Education as the Cornerstone to Providing Infusion Therapy in the Home

With the growing demand for home infusion therapy and the limitations being placed on the home care agencies, it is becoming increasing important for the home care nurse to have a clear method for addressing the needs of these patients. Education of the nurses, the patient, and caregiver(s) and carefully listening to determine their needs, fears, strengths, and weaknesses are critical. In addition, adaptation of the plan of care and teaching techniques to best meet the learners' needs, without compromising the quality of the care provided, are important to help ensure the safe and successful provision of home infusion therapy.