LONG-TERM PATIENT MANAGEMENT
Long-term post-surgical management ensures the greatest benefit from targeted drug delivery and continues throughout the course of the patient's treatment. Regular patient follow-up is necessary to ensure that the targeted drug delivery is providing optimal therapy outcomes, confirm the programmable infusion system component integrity and performance, and measure the battery life of the drug infusion pump.
Targeted drug delivery patient management considerations include:1
- Refilling the pump and programming dose adjustments
- Injecting into the catheter access port for diagnostic procedures
- Monitoring for patient outcomes and adverse events
- Managing therapy and system complications
- Managing patient achievement of goals documented before implant
PUMP REFILL APPOINTMENTS
The drug infusion pump is refilled by inserting a needle through the skin into the pump septum. The refill procedure involves a specific set of steps that must be followed precisely to help ensure patient safety during targeted drug delivery. Before clinicians perform refills, they must be trained in the correct procedures.
A typical refill appointment usually includes:
- Assessing the patient's general condition and response to targeted drug delivery
- Identifying the need for dose titration
- Confirming system performance
- Refilling the pump
- Determining the interval to the next refill
- Programming the pump
- Documenting patient care and prescribing information
- Conducting ongoing patient education about targeted drug delivery
- Scheduling the next refill appointment
The refill appointment provides an opportunity for clinicians to talk with patients and discuss their progress, thoughts, and questions. It also provides patients with a few minutes of one-on-one discussion with their clinician.
Use the refill appointment to observe the patient's condition, response to therapy, and overall emotional health and outlook.
TARGETED DRUG DELIVERY DOSE ADJUSTMENT
The SynchroMed™ II programmable infusion system is equipped for precise dose titration as well as flexible programmability for use during targeted drug delivery. The overall goal is to establish the drug dose that achieves optimal control without intolerable side effects or adverse events. Drug dosage will vary with each patient.
During refill appointments, it is important to observe patients for symptoms of drug overdose, tolerance, and ineffective dosing. Also emphasize to patients the importance of communicating unusual symptoms, signs of drug overdose or underdose, or loss of drug effect. If drug tolerance, disease progression, or psychosocial issues that may impact therapeutic effect are ruled out, evaluate the infusion system for malfunction. See SynchroMed product labeling for more information.
1
Prager, J., et al. (2014), Best Practices for Intrathecal Drug Delivery for Pain. Neuromodulation: Technology at the Neural Interface, 17: 354–372. doi:10.1111/ner.12146.