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

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 Unsettlingdown.wordpress.com (Berkowitz, 2009)

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 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)

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 Right Wrong

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 Bedside Monitoring Unit Procedure Room Unit Display Monitor Automated Responsiveness Monitor Handset (“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 Allergy to propofol Allergy to egg products or soy products Pregnant or lactating women Full Stomach (“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 Yellow alarm Red alarm that takes no drug action Red alarm that stops drug delivery (“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/productsandmedicalprocedur es/deviceapprovalsandclearances/recently- approveddevices/ucm353950.htm http://www.fda.gov/medicaldevices/productsandmedicalprocedur es/deviceapprovalsandclearances/recently- approveddevices/ucm353950.htm Sedation Redefined. (2014). In Sedays. Retrieved September 16, 2014, from http://www.sedasys.com/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 Nueroscience Nursing, 41(2), 115-120. (2009, April 1).