Recommendations for the Implementation of the Self-Administration of Alpha-1 Antitrypsin

Figures & data

Figure 1 The objectives, steps and recommendations for the implementation of a self-administration program of alpha-1 antitrypsin and the health professionals involved.

Abbreviations: AAT, alpha-1 antitrypsin; HCP, health care professional.

Box 1 Criteria of the Spanish Network on AAT Deficiency (REDAAT-SEPAR) for the Administration of Alpha-1 Antitrypsin Augmentation Therapy

Age over 18 years

Serious AAT deficiency demonstrated by serum concentrations ≤ 11 µM (60 mg/dl)

Nonsmokers or former smokers for at least the last 6 months

Pulmonary emphysema demonstrated by lung function tests and/or chest HRCT

COPD with FEV1 < 80% predicted who receive optimal pharmacological and nonpharmacological treatment

Not presenting an immunoglobulin Ac deficiency

Willing and able to receive regular treatment with AAT i.v. in day hospital

Note: REDAAT-SEPAR, Spanish Network on AAT deficiency- Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

Table 1 Role of Health Care Professionals in a Self-Administration Program

Specialist	Role
Pulmonology	Identify the candidate patients and assess their suitability for the program Assess treatment results, treatment satisfaction and adherence Identify complications arising from self-administration and provide potential solutions
Nurse	Train the patient/caregiver in self-administration Evaluate patient/caregiver’s technique and competence for self-administration.
Hospital pharmacy	Dispense treatment Assess adherence Ensure product traceability Pharmaco-therapeutic follow-up

Box 2 Nurse Checklist for the Management of Patients Included in a Self-Administration Program of AAT Therapy

Has been informed by the responsible pulmonologist.

Meets clinical and social criteria for inclusion in the self-administration program.

Has completed and signed the informed consent (this document must be included in the clinical records).

Has received training in the technique of self-administration and how to perform the treatment safely and effectively.

After the training process, the patient/caregiver is considered competent to carry out the self-administration of the treatment (this issue must be reflected in the clinical record).

Has been instructed to fill in the patient’s diary correctly.

Table 2 Key Points for the Training of the Patients on Self-Administration

Before Initiating the Training	During the Training^a
Prior consultation, on a different day than that selected for starting the self-administration, so that the responsible nursing staff can resolve doubts and provide the information that the patient may request in advance.	Preparation of the infusion area with an adequate level of asepsis.
Possibility of supervised self-administration in the hospital and, whenever is possible, in the patient’s home.	Checking and preparation of all the necessary material.
If possible, evaluation of the patient’s home as appropriate setting for self-administration.	Adequate reconstitution of the concentrate.
	Correct canalization.
	Appropriate infusion of the drug.
	Correct removal of the line once the infusion is finished.
	Correct storage of the drug at home and waste disposal (eg, needles).
	Appropriate procedure for documenting the infusion and informing the health professionals responsible of possible incidents arising during self-administration

Note: ^aThese points could be used as a checklist.