Caring safely @ home: Development of a subcutaneous medication support package for laycarers

Aim: The likelihood of home-based palliative patients remaining symptomatically well managed depends upon input from laycarers. Laycarers can experience stress and loss of confidence if required to prepare or administer subcutaneous injections. This study aimed to develop, implement and evaluate a package that supports laycarers to confidently and appropriately deliver subcutaneous medications.

Method: Palliative care and domiciliary services collaborated to develop the package. Resource development involved iterative processes with the goal of delivering competency-based education incorporating best-practice materials. Package implementation included training nurses to deliver standardized education to laycarers for the preparation and delivery of injections and resources uses. Evaluation utilised semi-structured questionnaires for laycarers and nurses. Outcome of primary interest was overall laycarer confidence that injections had been safely prepared and administered. Outcomes were measured on 7-point scales (endpoints of strongly disagree and strongly agree) documented post-education and repeated after a period of administering injections. Secondary outcomes concerned usefulness and relevance of package components.

Results: Resources developed included charts illustrating how to prepare and administer injections, demonstration kits, colour-coded injection labels, medication administration diary, competency check list, DVD focusing on injections and a medication booklet.
 
53 nurses and 106 laycarers completed evaluation forms, 49 laycarers provided data suitable for analysis using paired t-tests to investigate changes in mean ratings on outcome variables. Quantitative analysis is underway. Qualitatively laycarers evaluated the package positively, praising the education session though few viewed the DVD. Qualitatively nurses evaluated the standardized education as time-consuming, found the colour-coded labels useful and were critical of the practice of laycarers preparing medications.
 
Implications: This package enhances the capacity of laycarers to confidently and safely administer subcutaneous injections, thus supporting palliative patients to remain at home.