Safe Administration of Oral Baclofen in Patients with Cerebral ...Safe Administration of Oral...

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  • Safe Administration of Oral Baclofen in Patients with Cerebral Palsy Lucia C. Bastianelli, RN, MSN, CPNP, David J. Fogelman, MD, MSc

    Purpose  

               

    Background  and  Significance  

                 

    Implica6ons    

     Results        

                                               Implementa6on  

    Ø  Oral  Baclofen  is  used  for  pa1ents  with  spas1city  of  cerebral  and  spinal  origin  and  dystonic  disorders.  

    Ø   Our  pa1ent  popula1on  consists  of  children  with  Cerebral  Palsy  who  o;en  require  oral  baclofen.      

    Ø  Baclofen  comes  in  tablet  form  and  is  some1mes  compounded  into  liquid  form  for  ease  of  administra1on.  

    Ø   The  concentra1on  of  the  liquid  form  may  vary  depending  on  the  pharmacy.  

    Ø   This  can  place  the  pa1ent  at  risk  for  medica1on  errors.  

    Ø   The  symptoms  of  Baclofen  overdose  include:  hypotonia,  bradycardia,  respiratory  depression,  seizures  and  death.    

    Ø     The  symptoms  of  under  dosing  or  withdrawal  of  baclofen  include:    increase  or  return  of  spas1city,  hyperthermia,  and  change  in  mental  status,  hypotension,  and  itching.    

    Ø Administra1on  of  the  different  forms  of  enteral  baclofen  can  poten1ally  jeopardize  safety  to  pa1ents  with  spas1city.    

    Ø We  aim  to  describe  the  educa1onal  tools  we  developed  to  improve  the  safety  of  administra1on  of  enteral  baclofen.  

     

    Ø Poten1al  for  inconsistencies  in  the  concentra1on  of  the  compounded  form  may  result  in  under-‐  or  over-‐dose  errors.    

    Ø   As  a  result,  the  decision  was  made  to  u1lize  the  pill  form  whenever  possible.  However,  the  pills  need  to  be  diluted  for  enteral  administra1on,  which  is  more  complicated  for  the  families  and  requires  addi1onal  teaching.        

    Ø We  treat  a  diverse,  worldwide  pa1ent  popula1on  with  limited  English  proficiency  (LEP),  therefore  requiring  a  deeper  considera1on  when  developing  an  educa1on  program.  

    Ø   As  a  team,  consis1ng  of  a  physiatrist,  pediatric  nurse  prac11oner,  and  illustrator,  we  developed  Family  Educa1on  home  care  instruc1ons,  including  illustra1ons  for  visual  aide,  for  the  dilu1on  and  enteral  administra1on  of  Baclofen  tablets.    

    Ø   This  allows  for  safe  and  consistent  administra1on  of  oral  baclofen  therefore  minimizing  risk  of  an  overdose  or  withdrawal.    The  home  care  instruc1ons  have  been  translated  into  Arabic  and  other  languages  will  be  forthcoming.  

    Ø  In  conjunc1on  with  the  family  educa1on  home  care  instruc1on,  we  also  provide  demonstra1on  to  our  pa1ents  and  family/caregivers  of  the  proper  methods  of  preparing,  dilu1ng  and  administra1ng  of  the  medica1on.  

    Ø   In  order  to  ensure  complete  understanding  of  the  procedure  we  request  that  the  caregivers  demonstrate  the  steps  of  administra1on  for  us.    

    Ø This  feedback  method  coupled  with  the  home  care  instruc1ons,  minimizes  risk  and  provides  safe  administra1on  of  baclofen,  therefore  improving  quality  of  life  for  children  with  Cerebral  Palsy.  

    10  mg  tablet  dilu1on  instruc1ons                                      Dosage  schedule  with    gradual  weekly  increases    

    5  mg  tablet  Dilu1on  Instruc1on                                                  Dosage  schedule  with  gradual  weekly  increases  

                                                                     Weekly  gradual  increases  to  final  maintenance  dose        

    Special  thanks  to  our  Illustrator,    Brendan  Whipple,  and    Kris1n  Erekson  Barton,  Project  Mgr.  Health  Literacy  

    Lucia.Bas1anelli@childrens.harvard.edu  

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