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Palivizumab: a centralised clinic
Laura Marshall
RCN Conference
13th March 2008
Pavilizumab
Initially marketed in the late 1990’s to prevent the incidence of RSV+ in under two’s.
Due to lack of evidence and cost the JCVI made a tightened ‘at risk’ criteria for prescribing.
Therefore by utilising these guideline a local protocol was implemented.
Local criteria
Children under one year of age with chronic lung disease, receiving home oxygen therapy or prolonged oxygen use to a corrected gestational age of 36 weeks.
Infants less than six months of age with a haemodynamically
significant left to right shunt. Infants were selected at the discretion of the paediatric cardiologist
Children under two years of age with severe congenital immuno-deficiency.
Each child receives 5 doses (Oct-Feb) 15mg/kg of pavilizumab
Historical Background
Prior to the centralised clinic babies were receiving individual home visits by a CCN per dose or attending an outpatient facility
Implications: Time Cost Inability to vial share
In order to refine service delivery decided to pilot a centralised CCN led clinic
Working Party
Working party set up in March 2006: Lead CCN Paediatric Pharmacist Named Neonatologist Named Paediatrician
Overall aim to not only to minimise waste and cost but to increase amount of treated children
The clinic
One clinic a month (initially for 10 children)Central location with parkingAllocated appointments90 minute clinic ran by two nursesVial sharingIntegrated care pathwayPatient held records
Cost Analysis
YearChildren Treated
Total Drug Expenditure
(Doses given) Community
Ward Attender Inpatient
Average cost per
dose
2004/05 6 21, 484
(23)
16 5 2 £934
2005/06 10 36,226
(37)
13 17 7 £979
2006/07 16 32,080
(57)
47 0 10 £563
75 Nursing hours saved
Evaluation
100% attendance throughout seasonParent satisfaction questionnaire Variance trackingNo children were admitted to hospitalEffective social support for families
Season 2007/08
50 % increase in children100 % attendanceSuffolk PCT bought into the clinic for one
patient.
Conclusion
Nurse led services rapidly re shaping nursing services
Local CCNT provision variesCommunication between primary and
secondary care paramount
