New study shows x-ray as a potential means to check self-administered medication

A new pilot study has highlighted the potential of the use of x-ray in helping clinicians check if patients required to self-administered injectable medication over a period of time are doing so.

The study was carried out by a team of clinicians from Peninsula NHS Treatment Centre, Plymouth, UK and their findings have been published via poster at the International Pharmaceutical Federation (FIP) virtual research conference, FIP Virtual 2020.

Ensuring that patients adhere to a period of self-administered medication is recognised as fundamental to successful health outcomes. Patients may need to self-administer injectable medicines for a number of reasons, ranging from long term health conditions to post-surgery regimes.

Orthopaedic surgery is one of the specialties at Peninsula NHS Treatment Centre. A drug called low molecular weight heparin (LMWH) plays a vital role in preventing venous thromboembolism (VTE) after orthopaedic surgery. VTE is when a blood clot forms which if left untreated can lead to heart attack, stroke or other severe complications.

In this pilot study, the research team worked with foot surgery patients. For these procedures LMWH is self-administered by the patient via injection. The first dose is administered by a nurse after surgery and normally the patient is asked to self-administer the remainder of the course if capable. They are sent home with appropriate advice, dosage and equipment, and a sharps box with which to dispose of the used syringes.

To date, the most practical method of ensuring patients have administered LMWH according to instructions is by asking the patient with the hope they are truthful and/or accurate in their reporting. Opening a sharps box and counting syringes manually would be dangerous and against infection control protocols.

The research team wanted to see if a more accurate indication of whether or not a patient had self-administered as per instruction could be achieved by x-raying the sharps box.

It was thought that this might be a feasible method, given that the x-ray apparatus, manual counting and the counting software employed are easily-accessible and require minimal set-up.

A small cohort of foot surgery patients were asked to bring their full sharps box with them to their follow-up appointment. The boxes were x-rayed and the team performed a series of counting methods on the contents – counting by eye, using open-source imaging software and automated counting.

In this initial study, the research team found that x-ray has potential as an accurate and feasible means to assess patient adherence to a self-administered injectable medication regime.

The study was led by Pedro Martins, Pharmacy Manager at Peninsula NHS Treatment Centre. He said: “The imaging results clearly highlight and allow us to identify several components of the syringe: body, plunger, needle and needle guard coil. As it is made of metal, the coil gives us a clearly identifiable object image that enables an accurate counting to be made. Also by being extended we can conclude that the needle guard has been deployed, therefore the contents of the syringe have been used. The imaging parameters are adequate for the task.”

He added: “We have carried out this study with a small number of patients, because we were interrupted by the outbreak of the CO|VID-19 pandemic. This was a particular obstacle to fully deploying and analysing the automated counting method. More study is required, and we feel that a large-scale audit of returned sharps bins, when correlated with the patient record, may identify specific patient groups that have a reduced adherence to self-injectable medication.”

The study was carried out by Pharmacy Manager Pedro Martins, Radiology Manager Vanessa Squibb and Consultant Orthopaedic Surgeon James Brown, all from Peninsula NHS Treatment Centre. No personal or clinical patient information was recorded for the purpose of this research. Institutional approval was sought, and granted.

Peninsula NHS Treatment Centre offers a range of care options including orthopaedic, cataract and general surgery and endoscopic investigations. If a GP agrees that a patient needs treatment they can ask them to be referred to the hospital for treatment – it is part of the choice as an NHS patient and self-pay options are available.

It is the first hospital of its kind to have been awarded an overall ‘Outstanding’ rating by the Care Quality Commission.

More information is available by calling 01752 506070 or by visiting www.peninsulatreatmentcentre.nhs.uk