Successful implementation of a nurse-led teaching programme to independently administer subcutaneous methotrexate in the community setting to children with Crohn's disease

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Abstract

Background

Methotrexate is increasingly used as a third line immunosuppression agent in children with Crohn's disease (CD). Methotrexate is traditionally administered in the hospital setting.

Aim

To set up a nurse-led education programme to teach children/their parents to administer subcutaneous methotrexate in the community.

Methods

All patients were given methotrexate over a 16-month period. Patient demographics including previous treatments were collected. A competency based teaching package was implemented by the inflammatory bowel disease nurse. Distances and travel times together with costings were calculated.

Results

Thirty two patients (19 male; 13 female) with a median treatment age of 11.96 years (IQR 10.67–13.92) were studied. Thirty of 32 (17 children, 13 parents) were independently administering methotrexate. The median return journey distance to hospital was 23 miles (IQR 14.4–42.4) taking a median time of 52 min (IQR 41.0–73.5) for each injection. The total patient travel saving was £10 537 (average £730 per patient) and nursing time saving was £12 808 with home administration (total saving £23 345).

Conclusions

This paediatric study demonstrates that methotrexate injections can be given successfully in the majority (94%) of patients with CD independently in the community, resulting in significant time and money savings for patients and health professionals alike.

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