Director of Clinical Services - Nursing Amerita Greenwood Village, Colorado, United States
Background: Patients who have received institution-based infusions need an alternative care setting during the SARS-COV-2 pandemic. Ocrelizumab (OCR) has been delivered to patients at home; this study was important to reinforce the safety and positive outcomes for patients receiving this therapy using a shorter infusion protocol as a safer alternative to an outpatient treatment facility.
Purpose: To demonstrate the impact of collaboration and standardized nursing education between an academic institution and a home infusion specialty service on clinical outcomes for the home infusion patient
Methods: Interagency communication between an academic institution and a home infusion pharmacy was initiated to create a home infusion program for 100 MS patients who had received at least their 600 mg complete dose of Ocrelizumab. Electronic record systems between the two organizations were synchronized, and education was provided to the home infusion nurses from university infusion nurses to assure consistency of medication administration, assessment parameters and documentation of adverse events. Weekly meetings between the two organizations began in May of 2020 to implement the approved study design and implement a delivery and storage process. The first patient was infused in March, 2021, and the last patient of the study group received their infusion in January, 2022.
Results: A total of 99 patients have completed the study. Twenty-five out of 99 patients experienced an infusion related reaction (25.3%, 95% CI: (16.7%, 33.8%)). The majority (18 out of 25) had a grade 1 IRR (infusion related reaction) (18.2%, 95% CI: (10.6%, 25.8%)) and 7 patients had a grade 2 IRR (7.7%, 95% CI: (20.9%, 14.0%)). CTCAEs (spell out CTCAE) were self-reported in 66.7% of patients. Most common by occurrence were itching (n=34), fatigue (n=32), pain (n=15), headache/migraine (n=15), and gastrointestinal side effects (n=12). No SAEs (significant adverse events) occurred post-infusion. These patient reported outcomes (PROs) showed improvement pre vs post home infusion (higher is better): nurses explained things clearly (n=97, pre=3.73, post=3.88; p=0.0449); nurses treated with courtesy (n=98, pre=3.81; post=3.97; p=0.0023); felt safe and respected during infusion (n=98, pre=4.53, post=4.73; p=0.0041); felt comfortable in surroundings (n=98, pre=4.07; post=4.73; p< 0.0001); confidence in nurses administering infusion (n=97, pre=4.47, post=4.67; p=0.0109); and rated it as a better experience than infusion centers (n=97, pre=8.44; post=8.97; p=0.0046).
Discussion: OCR is safe to provide in the home and creates positive patient experiences. Home infusions have been occurring for years; however, some specialty medications have only been given in an infusion suite. This study exemplifies that an infusion pharmacy and academic institution can collaborate to provide positive experiences for patients in their homes. Additional studies could be completed to assess patient quality of life, satisfaction and safety of other medications typically administered in an infusion suite.
Conclusions: Study findings reinforce the safety of home administration of OCR, and also reinforce the positive responses of these patients. This information will be useful for physicians who have not yet prescribed this therapy for patients in their homes, and also illustrates the safety and efficacy of home-based infusions of OCR for payers.