Assessing the Acceptability and Cost Consequences of Implementing Elastomeric Devices for Administration of Intravenous Antibiotics at Home: A Mixed-Methods Evaluation

Abstract

Introduction

Pressure on NHS services necessitates implementation of innovative solutions to provide appropriate and cost-effective care. This study evaluates the acceptability, feasibility and cost-effectiveness of implementing home medication preparation and elastomeric device filling for the administration of intravenous antibiotics from the UK NHS perspective, focusing on regional implementation.

Method

A mixed-methods design included a targeted literature review, routine patient data, questionnaires tailored to participant groups (community clinicians, remote monitoring clinicians, consultants and patients), and interviews with both patients and clinicians. A total of 24 patients were recruited in Hertfordshire between June and September 2024. Piperacillin with tazobactam (Tazocin) or flucloxacillin was prepared and administered at the patients’ home by trained nurses and delivered by the elastomeric pump over 24 h. Economic evaluations compared this home pathway against three alternative pathways using preprepared medications: hospital inpatient care (hospital), outpatient clinic visits (outpatient) and a hypothetical home visit (hypothetical).

Findings

Survey responses were collected from 14 clinicians, five patients and two carers, and interviews were conducted with six clinicians, one patient, and one carer. Patients and carers were satisfied with the home pathway because of the perceived safety and freedom it gave them. Clinicians expressed positive feedback and considered it feasible, provided there was sufficient support for themselves and patients. Concerns were raised about design, ease of filling the elastomeric device and monitoring flow of medication. Other issues related to the type of cannula and concentration of the vials, improvements for care packages, communication and training. The home pathway demonstrated cost savings, with a per-patient cost of £2507.54, significantly lower than the hospital pathway (£6122.70), outpatient pathway (£3603.76), and hypothetical pathway (£4373.37).

Conclusion

Overall, clinicians, patients and carers were pleased with the home pathway, with the additional benefit that the home pathway could be economically and realistically feasible to help the NHS meet the growing demand for high-quality care.