February 1, 2021 astruble

Providing Injection Support

This week's Care Corner Blog is a patient story shared to us by our clinical pharmacist, Lauren Skilton, who went above and beyond to help her patient feel comfortable with his new injection medication. Pharmacists like Lauren Skilton implement our culture of kindness every day for our patients and help them lead healthier, happier lives. Here's Lauren's story:

"I recently had a very pleasant conversation with a patient who was newly starting on Humira. This patient's past medical history showed a significant traumatic brain injury, which resulted in some cognitive deficits. Our pharmacy liaison primarily communicated with his sister, who manages his medications and pays the co-pay. I requested that we get the patient's direct line to communicate directly with him. When I reached him that day, he had already received his Humira and injected it himself.

When I inquired about his injection technique, he told me that he watched a Youtube video before injecting his medication into his arm right above the elbow's crease. I then counseled the patient extensively on proper injection techniques. Together we reviewed the correct injection sites and the need to rotate sites, avoid any tender/bruised/scarred skin. I also reminded him that he needs to use alcohol swabs to disinfect the area and wait for the site to dry before injection. Lastly, we reviewed how to inject the pen by holding it against the skin for 10-15 seconds to ensure all medication was injected and dispose of it properly.

I then asked the patient to repeat the steps back to confirm that he was aware of the correct injection sites and that from now on, he should only inject into the abdomen (at least 2" from the belly button) thighs. From our conversation, I gathered that he was unaware that each pen only contained one dose, and he had replaced the used pen in the fridge.

Therefore, I reminded him that each pen only has one dose and should be appropriately disposed of in a red sharps container once the dose is injected. I then provided the patient with several resources, including Humira's direct line, a nursing line, and a patient support program, and their website which hosts many useful videos. Before we ended our call, I let him know I would give him a call on the morning of his next injection so we could walk through the steps together.

When I phoned the patient on the morning of his second injection, he told me he had already injected himself. So I had him walk me through how the injection went, including where he injected himself, which was abdomen, 3" from the belly button, and confirming that he disinfected the area first. He even let me know he disposed of the pen in the sharps container after injecting. Since I felt confident he now understood the process, we once again walked through the injection steps and confirmed that he should rotate sites (abs, thighs) with each injection for his next injection.

During our conversation, the patient also mentioned that he allowed the medication to warm for about 15 mins before injection. I confirmed with Humira that warming to room temp does not impact efficacy but rather improves injection site reactions for certain patients. Even though the patient let me know he was not experiencing any injection site reactions, I still let him know that if any reactions did appear, he should allow the medication to warm before injection as he had done.

Since Humira offers an excellent patient program, I asked the patient if he thought about signing up. He told me that he had heard of the program and was interested but had not gotten around to signing up yet. Therefore, I let him know I would be happy to sign-up on his behalf while talking over the phone. I made sure to also walk him through all of the program's benefits, such as his own Nurse Ambassador, an injection reminder service, additional injection support via videos, and a travel kit for Humira pens free of charge.

He requested a Travel Kit, which I in turn request from Humira, and asks that reminders be sent via email at 6:30 AM on injection days. I sent this up for him and provided him with a generic password that he can change. I encouraged him to interact with the website, which I offered him, as it has many resources. This patient was very appreciative of the close follow-up. He has saved our clinical line number and knows we are reachable every day as a resource to him. Before we hung up, I made sure to let this patient know that our clinical team will continue to follow him closely to ensure he is injecting correctly, tolerating the medication well, and noting therapeutic effects."