Informal caregivers’ preparation and administration of home hospice prescribed injectable subcutaneous drugs – a prospective observational pilot study

Introduction
Patients at the end-of-life often require subcutaneously administered medications. At present it is impossible for hospice home care nurses to prepare ampule drugs before each administration. Aim of the study: To assess the feasibility of the preparation and administration of these drugs in practice.

Material and methods
The training was performed on 37, not previously instructed, adult informal caregivers. A written medical order from the authorial home medication template and the step-by-step drug preparation instruction were used. The percentage of persons who successfully passed the training self-performed the procedure properly directly after the education and a week later were assessed. We monitored the adverse events in drug preparation or administration and the number of both planned and intervention visits of the hospice team, external consultations, and hospitalisations within a week of observation.

Results
The educated persons (typically close female relatives) described the procedure as easy to perform. All of them were able to prepare drugs properly and were confidently convinced of it, both directly after the training and after a week of practice. There were few local adverse events of subcutaneous injections. In one case an incorrect drug dose was noticed. Thirty-four patients remained under hospice home care until their death. Two hospice ward deaths were associated with the increasing dependency on incremental caregivers’ insufficiency, and one hospital death was linked to the rapid deterioration of the patient’s condition.

Conclusions
The effective training of informal caregivers of hospice home care patients in the independent and safe preparation and administration of ampule drugs is feasible.