Administration & observation Room
Number of rooms eligible for treatment
Is the site ready for SPRAVATO® ?
What is the SPRAVATO® (TRD*) treatment and visit pathway?
*SPRAVATO®, in combination with a SSRI or SNRI, is indicated for adults with treatment-resistant Major Depressive Disorder, who have not responded to at least two different treatments with antidepressants in the current moderate to severe depressive episodeSPC
Induction phase
Two sessions per week
Maintenance phase
One session per week
One session per week or every two weeks
9+ weeks
Standard session pathway
Arrive at site
Waiting room
Consultation
Administration
The patient self administers SPRAVATO® under the supervision of an HCP.
Post administration observation
Patient is monitored by nurse until clinically stable and deemed ready to leave.
Leave site
What is needed for administering SPRAVATO® ?
Chair
Total number of chairs in these rooms
Blood pressure monitor
Is there enough blood pressure monitoring equipment?
HCP time
Physician(s) to be involved
Nurse(s) to be involved
Safe storage
Is there storage available to safely store the SPRAVATO® nasal sprays?
What are options for improving the pathway?
Results:
Patient "carer" involved in pathway
Allow for the patient to be accompanied by a ‘carer’ (e.g. spouse, family member, friend), who could be with the patient during the post-administration observation, and help the patient throughout the journey.
Simplified administration system
Implement a simplified administration system, as often used for indications with frequent hospital visits, for decreasing the administrative burden for the patient (e.g. no registration at a desk and use of ID card), allowing for easier access to the observation room and faster treatment start.
Patient profile tracking
Make notes of individual patient experience on treatment so it can be used for subsequent treatment sessions to optimise their experience.
Site of care layout
Optimised location and layout of Site of Care while considering the flow of patients and considering specific needs, e.g. disabled people. Improve traffic flow (e.g. observation rooms close to admission desk or secondary entrance) and eliminate redundancy (e.g. avoid 2 steps admissions).
Storage location optimisation
Set-up a (dedicated) storage location close to the treatment location(s).
End-of-day treatment
Set-up of an end-of-day treatment schedule for allowing patients to keep their day scheduled unaltered, e.g. allowing to drive or use machinery during the morning and early afternoon.
How to best organise the practice?
How much time is spent with the patient?
Standard session pathway
min
week(s)
min
min
Standard duration & frequency of treatment
Treatment duration in weeks
Number of weeks between sessions during maintenance
How many patients can be taken care of on site?
Room(s)
Room(s)
Hour(s)/week
Chair(s)
Nurse(s)
Nurse(s)
Hour(s)/week
Dedicated observation time
%
Physician(s)
Physician(s)
Hour(s)/week
Aspiration of patients treated in a year
Theoretical maximum number of patients per year:
Number of patients seen (sessions) in a week:
Number of patients ramp-up
Impact of adding:
- h/w for room(s):
- h/w for nurse(s):
- h/w for physician(s):
07:00
08:00
09:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00
Mon.
Tue.
Wed.
Thu.
Fri.
Sat.
Sun.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
07:00
08:00
09:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00
23:00
C
N
P
S
C
N
P
S
C
N
P
S
C
N
P
S
C
N
P
S
C
N
P
S
C
N
P
S
1
2
3
4
5
Number of HCP's/rooms
Number of sessions
C Chairs
N Nurses
P Physicians
S Sessions
What are options for organising the site most efficiently?
Results: 11
Optimised staffing approach
Change the staffing mix to decrease overall cost of effort for taking care of patients (e.g. leverage junior nurses for post-administration observation of known patients, optimised frequency of physician consultations).
Efficient observation time planning
In a prolonged observation phase, the available free time can efficiently be used by the nurse to do additional work. E.g. administrative work …
Joint patient observation
For the maintenance phase of the treatment, set-up a dedicated room with the necessary equipment for administration and post- …
Low-utilisation infrastructure
The use of under-utilised infrastructure (e.g. specific times) of neighbouring departments (e.g. oncology).
Site of Care partnerships
Set-up of partnerships with other Sites of Care. E.g. for allowing treatment during non-induction phases, with Sites of Care within the responsibility of the hospital pharmacy.
Low-peak timeslot treatment
Set-up of a dedicated timeslot for treatment that is currently known to be underutilised by the nurses (i.e. because inpatients are in treatment/therapy, sleeping, less patients on Monday and Friday, …).
Neighbouring rooms
Organise administration & post-administration observation in rooms next to / close to each other, potentially allowing a nurse to observe multiple patients at the same time.
Part-time nurse practitioner
Utilise flexible staff planning (e.g. part time nurses) in order to schedule more patients on some part of the days / some day, and leverage infrastructure availability.
Optimised discharge
Organise HCP time to allow for smooth discharge of patients by leveraging the discharge readiness checklist, e.g. ensuring availability of a physician at scheduled treatment end (and therefore avoiding to keep patients in the Site of Care while post-administration observation is complete).
Remote observation
Support and increase efficiency of the observation phase using tele-observation (i.e. the observation of a patient within the hospital using dedicated equipment like beepers or camera supervision) of multiple patients by a single nurse.
ECT reconversion
Reconvert (part of) ECT rooms and reallocate ECT staff for product use.
What is the value for the site?
What are the priority drivers in site of care decision making?
What is the budget impact of implementing SPRAVATO® ?
Opportunity cost
Physician time dedicated to SPRAVATO®
hour(s)
Weekly working time
hour(s)
%
Nurse time dedicated to SPRAVATO®
hour(s)
Weekly working time
hour(s)
%
Room time dedicated to SPRAVATO®
hour(s)
Weekly available time
hour(s)
%
Out of pocket costs
| Total | Fixed costs 0€ |
Variable costs 0€ |
|
|---|---|---|---|
| € | € | ||
| € | € | ||
| € | € | ||
| € | € | ||
What are the options for funding SPRAVATO® ?
Reimbursement product
SPRAVATO® readiness
Dear Sir/Madam, please find below the minutes of our discussion.
Actions
Pathway
Resource utilisation & capacity
Value
Privacy policy and legal disclaimer
Privacy Policy
This tool does not collect any personal data from its users. Non-personal data collected for the provision of services are solely for the purposes of internal reporting and targeting. Non-personal data which is being collected may include but is not limited to data on equipment / infrastructure / HCP volume vs. requirements (e.g. number of rooms, chairs, existence of blood pressure monitoring equipment, existence of safe storage space, number of physicians and nurses within the team); opening hours of site; volume of available hours for rooms, physicians and nurses; estimation of time spent on consultation, administration and monitoring for SPRAVATO® ; ‘expected number of patients’ to be treated with SPRAVATO® ; costs estimates (fixed and variable) of possible investment; working time estimate of physicians & nurses; status on recommendations, with possible answers being: already in place, to be done, not relevant; and an option to add own recommendation for improvement on infrastructure/capacity/value creation.
In some cases, we may also collect data obtained directly from you when you decide to communicate such data to us (e.g., your professional email address for us to send you the minutes of the discussion, or through open fields ‘notes’ and ‘actions to be taken’ per module). By using this application, you acknowledge that Johnson & Johnson will process the personal data you provide for the purpose of internal anonymized reporting and targeting. In such case, Johnson & Johnson will retain your data for as long as necessary for the provision of SoC Activation Tool services (e.g. email address is deleted after sending you the minutes by email). For more information, please read our Privacy Policy.
If you provide personal data concerning other individuals than yourselves you acknowledge that you have the right to provide such personal data, and that such individuals have been informed about, and agree to the processing of their personal data as per requirements in applicable data protection law. No data regarding personal patient information should be recorded via this tool.
Disclaimer
By using this Application, you are agreeing to be bound by the following terms and conditions.
The information on this Application is intended to furnish users with general information on matters that they may find to be of interest.
While every effort has been made to offer current and accurate information, errors can occur.
Furthermore, this Application may contain references to certain laws and regulations. Laws and regulations will change over time and should be interpreted only in light of particular circumstances.
JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY AND RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS IN THE CONTENT CONTAINED ON THIS APPLICATION.
All content on the Application and all services provided through it are provided “as is”, with no guarantees of completeness, accuracy or timeliness, and without representations, warranties or other contractual terms of any kind, express or implied.
Johnson & Johnson does not represent or warrant that this Application, the various services provided through this Application, and / or any information, software or other material downloaded from this Application, will be accurate, current, uninterrupted, error-free, omission-free or free of viruses or other harmful components.
TO THE FULLEST EXTENT PERMISSIBLE PURSUANT TO APPLICABLE LAW, JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY TO YOU AND EVERYONE ELSE IN RESPECT OF THE CONTENT ON THIS APPLICATION AND ALL SERVICES PROVIDED THROUGH IT, WHETHER UNDER ANY THEORY OF TORT, CONTRACT, WARRANTY, STRICT LIABILITY OR NEGLIGENCE OR OTHERWISE, AND WHETHER IN RESPECT OF DIRECT, INDIRECT, CONSEQUENTIAL, SPECIAL, PUNITIVE OR SIMILAR DAMAGES, EVEN IF JOHNSON & JOHNSON WAS ADVISED, KNEW OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF SUCH DAMAGES.
Johnson & Johnson reserves the right to alter or delete material from the application at any time, and Johnson & Johnson may, at any time, revise the terms and conditions, the legal disclaimer or other policies set forth in this application by updating it. Such modifications shall be deemed effective immediately upon posting on Johnson & Johnson’s application. Any continued use of the application shall be deemed conclusive of your acceptance of the modified terms and conditions, the legal disclaimer of Johnson & Johnson and other policies.
Useful references
User guide
Display
Show
Hide
Pathway
What is the SPRAVATO® (TRD*) treatment and visit pathway?
What is needed for administering SPRAVATO® ?
Administration and observation room
Chair
Blood pressure monitoring
HCP time
Safe storage
What are the options for improving the pathway?
Show
Hide
Resource utilisation & capacity
How much time is spent with the patient?
How many patients can be taken care of on site?
What are the options for organising the site most efficiently?
Show
Hide
Impact & Performance
What are the priority drivers in site of care decision making?
What is the budget impact of implementing SPRAVATO® ?
Opportunity cost
Out of pocket costs
What are the options for funding SPRAVATO® ?
Show
Hide
Summary setup
Actionables
Notes on pathway
Notes on resource utilisation & capacity
Notes on impact & performance
Privacy Policy
This tool does not collect any personal data from its users. Non-personal data collected for the provision of services are solely for the purposes of internal reporting and targeting. Non-personal data which is being collected may include but is not limited to data on equipment / infrastructure / HCP volume vs. requirements (e.g. number of rooms, chairs, existence of blood pressure monitoring equipment, existence of safe storage space, number of physicians and nurses within the team); opening hours of site; volume of available hours for rooms, physicians and nurses; estimation of time spent on consultation, administration and monitoring for SPRAVATO® ; ‘expected number of patients’ to be treated with SPRAVATO® ; costs estimates (fixed and variable) of possible investment; working time estimate of physicians & nurses; status on recommendations, with possible answers being: already in place, to be done, not relevant; and an option to add own recommendation for improvement on infrastructure/capacity/value creation.
In some cases, we may also collect data obtained directly from you when you decide to communicate such data to us (e.g., your professional email address for us to send you the minutes of the discussion, or through open fields ‘notes’ and ‘actions to be taken’ per module). By using this application, you acknowledge that Johnson & Johnson will process the personal data you provide for the purpose of internal anonymized reporting and targeting. In such case, Johnson & Johnson will retain your data for as long as necessary for the provision of SoC Activation Tool services (e.g. email address is deleted after sending you the minutes by email). For more information, please read our Privacy Policy.
If you provide personal data concerning other individuals than yourselves you acknowledge that you have the right to provide such personal data, and that such individuals have been informed about, and agree to the processing of their personal data as per requirements in applicable data protection law. No data regarding personal patient information should be recorded via this tool.
Disclaimer
By using this Application, you are agreeing to be bound by the following terms and conditions.
The information on this Application is intended to furnish users with general information on matters that they may find to be of interest.
While every effort has been made to offer current and accurate information, errors can occur.
Furthermore, this Application may contain references to certain laws and regulations. Laws and regulations will change over time and should be interpreted only in light of particular circumstances.
JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY AND RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS IN THE CONTENT CONTAINED ON THIS APPLICATION.
All content on the Application and all services provided through it are provided “as is”, with no guarantees of completeness, accuracy or timeliness, and without representations, warranties or other contractual terms of any kind, express or implied.
Johnson & Johnson does not represent or warrant that this Application, the various services provided through this Application, and / or any information, software or other material downloaded from this Application, will be accurate, current, uninterrupted, error-free, omission-free or free of viruses or other harmful components.
TO THE FULLEST EXTENT PERMISSIBLE PURSUANT TO APPLICABLE LAW, JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY TO YOU AND EVERYONE ELSE IN RESPECT OF THE CONTENT ON THIS APPLICATION AND ALL SERVICES PROVIDED THROUGH IT, WHETHER UNDER ANY THEORY OF TORT, CONTRACT, WARRANTY, STRICT LIABILITY OR NEGLIGENCE OR OTHERWISE, AND WHETHER IN RESPECT OF DIRECT, INDIRECT, CONSEQUENTIAL, SPECIAL, PUNITIVE OR SIMILAR DAMAGES, EVEN IF JOHNSON & JOHNSON WAS ADVISED, KNEW OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF SUCH DAMAGES.
Johnson & Johnson reserves the right to alter or delete material from the application at any time, and Johnson & Johnson may, at any time, revise the terms and conditions, the legal disclaimer or other policies set forth in this application by updating it. Such modifications shall be deemed effective immediately upon posting on Johnson & Johnson’s application. Any continued use of the application shall be deemed conclusive of your acceptance of the modified terms and conditions, the legal disclaimer of Johnson & Johnson and other policies.
Privacy policy and legal disclaimer
This tool does not collect any personal data from its users. Non-personal data collected for the provision of services are solely for the purposes of internal reporting and targeting. Non-personal data which is being collected may include but is not limited to data on equipment / infrastructure / HCP volume vs. requirements (e.g. number of rooms, chairs, existence of blood pressure monitoring equipment, existence of safe storage space, number of physicians and nurses within the team); opening hours of site; volume of available hours for rooms, physicians and nurses; estimation of time spent on consultation, administration and monitoring for SPRAVATO® ; ‘expected number of patients’ to be treated with SPRAVATO® ; costs estimates (fixed and variable) of possible investment; working time estimate of physicians & nurses; status on recommendations, with possible answers being: already in place, to be done, not relevant; and an option to add own recommendation for improvement on infrastructure/capacity/value creation.
In some cases, we may also collect data obtained directly from you when you decide to communicate such data to us (e.g., your professional email address for us to send you the minutes of the discussion, or through open fields ‘notes’ and ‘actions to be taken’ per module). By using this application, you acknowledge that Johnson & Johnson will process the personal data you provide for the purpose of internal anonymized reporting and targeting. In such case, Johnson & Johnson will retain your data for as long as necessary for the provision of SoC Activation Tool services (e.g. email address is deleted after sending you the minutes by email). For more information, please read our Privacy Policy.
If you provide personal data concerning other individuals than yourselves you acknowledge that you have the right to provide such personal data, and that such individuals have been informed about, and agree to the processing of their personal data as per requirements in applicable data protection law. No data regarding personal patient information should be recorded via this tool.
Disclaimer
By using this Application, you are agreeing to be bound by the following terms and conditions.
The information on this Application is intended to furnish users with general information on matters that they may find to be of interest.
While every effort has been made to offer current and accurate information, errors can occur.
Furthermore, this Application may contain references to certain laws and regulations. Laws and regulations will change over time and should be interpreted only in light of particular circumstances.
JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY AND RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS IN THE CONTENT CONTAINED ON THIS APPLICATION.
All content on the Application and all services provided through it are provided “as is”, with no guarantees of completeness, accuracy or timeliness, and without representations, warranties or other contractual terms of any kind, express or implied.
Johnson & Johnson does not represent or warrant that this Application, the various services provided through this Application, and / or any information, software or other material downloaded from this Application, will be accurate, current, uninterrupted, error-free, omission-free or free of viruses or other harmful components.
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Privacy Policy
This tool does not collect any personal data from its users. Non-personal data collected for the provision of services are solely for the purposes of internal reporting and targeting. Non-personal data which is being collected may include but is not limited to data on equipment / infrastructure / HCP volume vs. requirements (e.g. number of rooms, chairs, existence of blood pressure monitoring equipment, existence of safe storage space, number of physicians and nurses within the team); opening hours of site; volume of available hours for rooms, physicians and nurses; estimation of time spent on consultation, administration and monitoring for SPRAVATO® ; ‘expected number of patients’ to be treated with SPRAVATO® ; costs estimates (fixed and variable) of possible investment; working time estimate of physicians & nurses; status on recommendations, with possible answers being: already in place, to be done, not relevant; and an option to add own recommendation for improvement on infrastructure/capacity/value creation.
In some cases, we may also collect data obtained directly from you when you decide to communicate such data to us (e.g., your professional email address for us to send you the minutes of the discussion, or through open fields ‘notes’ and ‘actions to be taken’ per module). By using this application, you acknowledge that Johnson & Johnson will process the personal data you provide for the purpose of internal anonymized reporting and targeting. In such case, Johnson & Johnson will retain your data for as long as necessary for the provision of SoC Activation Tool services (e.g. email address is deleted after sending you the minutes by email). For more information, please read our Privacy Policy.
If you provide personal data concerning other individuals than yourselves you acknowledge that you have the right to provide such personal data, and that such individuals have been informed about, and agree to the processing of their personal data as per requirements in applicable data protection law. No data regarding personal patient information should be recorded via this tool.
Disclaimer
By using this Application, you are agreeing to be bound by the following terms and conditions.
The information on this Application is intended to furnish users with general information on matters that they may find to be of interest.
While every effort has been made to offer current and accurate information, errors can occur.
Furthermore, this Application may contain references to certain laws and regulations. Laws and regulations will change over time and should be interpreted only in light of particular circumstances.
JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY AND RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS IN THE CONTENT CONTAINED ON THIS APPLICATION.
All content on the Application and all services provided through it are provided “as is”, with no guarantees of completeness, accuracy or timeliness, and without representations, warranties or other contractual terms of any kind, express or implied.
Johnson & Johnson does not represent or warrant that this Application, the various services provided through this Application, and / or any information, software or other material downloaded from this Application, will be accurate, current, uninterrupted, error-free, omission-free or free of viruses or other harmful components.
TO THE FULLEST EXTENT PERMISSIBLE PURSUANT TO APPLICABLE LAW, JOHNSON & JOHNSON DISCLAIMS ALL LIABILITY TO YOU AND EVERYONE ELSE IN RESPECT OF THE CONTENT ON THIS APPLICATION AND ALL SERVICES PROVIDED THROUGH IT, WHETHER UNDER ANY THEORY OF TORT, CONTRACT, WARRANTY, STRICT LIABILITY OR NEGLIGENCE OR OTHERWISE, AND WHETHER IN RESPECT OF DIRECT, INDIRECT, CONSEQUENTIAL, SPECIAL, PUNITIVE OR SIMILAR DAMAGES, EVEN IF JOHNSON & JOHNSON WAS ADVISED, KNEW OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF SUCH DAMAGES.
Johnson & Johnson reserves the right to alter or delete material from the application at any time, and Johnson & Johnson may, at any time, revise the terms and conditions, the legal disclaimer or other policies set forth in this application by updating it. Such modifications shall be deemed effective immediately upon posting on Johnson & Johnson’s application. Any continued use of the application shall be deemed conclusive of your acceptance of the modified terms and conditions, the legal disclaimer of Johnson & Johnson and other policies.
Arrival at site
When arriving at the site, the patient registers at the front desk/reception. Afterwards the patient will be directed towards the appropriate room. The patient may or may not be joined by a carer.
Waiting room
The patient waits in the waiting room until they are invited into a consultation room or taken directly for treatment administration.
Consultation
Consultations are key, particularly at the beginning of the journey. After that, consultations are ‘ad hoc’ depending on the patient and the need for a consultation. The physician can discuss the efficacy of the treatment, potential side effects, etc.
How to administer SPRAVATO®
Pre-administration
- Blood pressure should be measured before SPRAVATO® administration
- If a patient’s blood pressure is elevated (cf. risk minimization guide (for HCPs)), please reconfirm their blood pressure
- If a patient’s blood pressure is still elevated, consider lifestyle or pharmacological intervention to reduce blood pressure prior to starting SPRAVATO® treatment
- Consider the individual patient’s benefit and risk before deciding whether to delay SPRAVATO® treatment
Administration
SPRAVATO® is intended to be self‑administered by the patient under the direct supervision of a healthcare professional. A treatment session consists of nasal administration of SPRAVATO® and a post‑administration observation period in settings where this can be performed. Please refer to the dosing and administration guide or to the summary of product characteristics (SmPC) for full details of prescribing information.
-
Step 1 Get ready
-
Step 2 Prepare device
-
Step 3 Prepare patient
It is recommended that healthcare professionals wear protective gloves while assisting patients
At each session, instruct patient to blow nose before first device only
Confirm required number of devices
Check expiration date (’EXP’)
If expired, get a new device
Peel blister and remove device
Do not prime device – this will result in a loss of medication
Check that indicator shows 2 green dots. If not, dispose of device and get a new one
Hand device to patient
Patient should:
Hold device as shown with the thumb gently supporting the plunger
Do not press the plunger
Recline head at about 45 degrees during administration to keep medication inside the nose
-
Step 4 Patient sprays once into each nostril
-
STEP 5 Confirm delivery
and rest
Patient Should:
Insert tip straight into the first nostril
Nose rest should touch the skin between the nostrils
Patient should:
Breathe in through nose while pushing plunger all the way up until it stops
Sniff gently after spraying to keep medication inside nose
Switch hands to insert tip into the second nostril
Take device from patient
Check that indicator shows no green dots. If you see a green dot, have patient spray again into the second nostril
Check indicator again to confirm device is empty
Patient should:
Rest in a comfortable position (preferably, semi-reclined) for 5 minutes after each device
Do not blow nose
If liquid drips out, dab nose with a tissue
Ensure that the patient waits 5 minutes after each device to allow medication to absorb
Post administration observation
Patient should be monitored for any transient side effects including dissociation, sedation and increase in blood pressure, until patient is clinically stable based on clinical judgment.
Leave site
WARNING: Before SPRAVATO® administration, patients should be instructed not to engage in potentially hazardous activities requiring complete mental alertness and motor coordination, such as driving a vehicle or operating machinery, until the next day following a restful sleep (see section 4.4). SPC
Readiness-to-leave checklist for healthcare professionals
Clinical assessment
- Have you confirmed that the patient does not have signs of dissociation or perceptual changes that might impair their functioning?
- Have you confirmed that the patient is not experiencing sedation (i.e. the patient is fully awake and responding to stimuli)?
- Are the patient’s blood pressure values at acceptable levels?
- Have any other adverse events resolved?
- Have you advised the patient that they should not drive or operate machinery until the next day following a restful sleep?
- Has the patient planned to travel home by public transport or arranged for someone else to drive them home?
- Do you, the treating physician, believe the patient is ready to leave the healthcare facility based on your clinical judgement?
Administration & observation room
In order to be able to implement SPRAVATO® within the site of care, eligible rooms need to be available for patients.
The rooms need to be suitable for (1) administration of the product and (2) for post administration observation. These 2 steps do not need to occur in different rooms.
Arrival at site
Time spent in this step is not expected to involve an HCP.
Chair
In order to be able to implement SPRAVATO® within the site of care, chairs need to be in place.
Reclining chairs are not required but may be more comfortable for patients, who need to lean back with an angle of 45° during the administration step.
Waiting room
Time spent in this step is not expected to involve an HCP.
Blood pressure monitor (Sphygmometer)
In order to be able to implement SPRAVATO® within the site of care, blood pressure a monitoring device
needs to be in place to measure the patients’ blood pressure before and after the self-administration. Several
devices might be needed depending on the number of patients.
Consultation
Evidence of therapeutic benefit should be evaluated at the end of induction phase to determine need for continued treatment. SPC
The need for continued treatment should be reexamined periodically. SPC
Assessment of contraindications and concomitant medications should take place, plus patient medical history (and assessment of history of substance abuse).
There will be a consultation before the first administration, where the physician will check suitability for treatment (e.g. contra-indications, need for lifestyle or pharmacological intervention prior to starting SPRAVATO ® treatment in case of elevated blood pressure...). The decision to prescribe SPRAVATO® should be determined by a psychiatrist.SPC
At the end of induction period there will be a consultation to check for evidence of therapeutic benefit. Consultations during the maintenance phase will check for dosing frequency and the need for continued treatment.
HCP time
Implementing SPRAVATO® within the site of care will require healthcare professional(s) to be available for the administration and post administration observation period.
Spravato is intended to be self-administered by the patient under the direct supervision of a healthcare professional.The patient then needs to observed by a healthcare professional during a post administration observation period.SPC
Safe storage
The nasal sprays needs to be stored in a dry, safe compartment preferably close to the location where the SPRAVATO® is being administered. The disposal of the device depends on the local region.
Administration
Blood pressure should be assessed prior to dosing with SPRAVATO®. In patients whose blood pressure prior to dose administration are judged to be elevated (as a general guide: >140/90 mmHg for patients <65 years of age and >150/90 mmHg for patients ≥65 years of age), it is appropriate to adjust lifestyle and/or pharmacologic therapies to reduce blood pressure before starting treatment with SPRAVATO®. SPC
Post administration observation
Patients should be monitored by a healthcare professional after SPRAVATO® administration at each treatment session:
- Measure the patients blood pressure at around 40 minutes after administration of the first dose of SPRAVATO. If their blood pressure is elevated, continue to regularly measure it until it returns to acceptable levels.
- Regularly monitor the patient for signs of dissociation, sedation and any other adverse events.
- Approximately half (≥44.3%) of patients are ready to be discharged within 1 hour. - Popova V, et al. Am J Psychiatry 2019;176(6):428-438.
- Almost all (93.2%) patients are ready to be discharged within 90 minutes. - Popova V, et al. Am J Psychiatry 2019;176(6):428-438.
Leave site
Readiness to leave checklist is available to help assess when a patient is ready to leave the site of care.
Impact on patient
Impact on site of care
Requirements
Impact on patient
Impact on site of care
Requirements
Impact on patient
Impact on site of care
Requirements
Impact on patient
Impact on site of care
Requirements
Add option for priority drivers in site of care decision making
Edit option
Patient "carer" involved in pathway
- ++ Arrive at & leave site
- ++ Administration
- +++ Pos-administration observation
Allow for the patient to be accompanied by a ‘carer’ (e.g. spouse, family member, friend), who could be with the patient during the post-administration observation, and support the patient throughout the journey.
Impact on patient
- Patient supported by a known person
Impact on site of care
- Observation may be done more efficiently with 'carer' support
- Reduction in observation phase HCP effort as emotional and practical support of certain side effects are taken up by ‘carer’ (e.g. anxiety, dissociation)
Requirements
- Ability / capacity for the ‘carer’ to support the patient during clinic appointments and on the way to and from the clinic (can e.g. be combined with other options)
- Willingness from the board/psychiatrist to allow ‘carer’ in administration and post-administration observation environment
Simplified administration system
- ++ Arrive at site
Implement a simplified administration system, as often used for indications with frequent hospital visits, for decreasing the administrative burden for the patient (e.g. no registration at a desk and use of ID card), allowing for easier access to the observation room and faster treatment start.
Impact on patient
- Easier access to treatment
- Less time spent in the site of care
Impact on site of care
- Minimised impact of busy periods at administration desk on the patient arrival pattern (i.e. decrease in people turning up late for treatment)
Requirements
- Infrastructure requirements (patient badges, …)
- Payment and administrative system dapted to such a set-up (e.g. for payment)
Patient profile tracking
- +++ Post-administration observation
Make notes of individual patient experience on treatment so it can be used for subsequent treatment sessions to optimise their experience.
Impact on patient
- Allows for personalised approach of treatment for the patient
Impact on site of care
- Better knowledge and history of patient side effects during observation phase
- Higher administrative requirements for nurses
- Investment in profile template creation required
Requirements
- Deployment of a tool and/or procedures for tracking patient specificities
- When patient information is already in place, this can be leveraged for an holistic patient overview
Hospital layout
- + Total pathway
Optimised location and layout of site of care while considering the flow of patients and considering specific needs, e.g. disabled people. Improve traffic flow (e.g. observation rooms close to admission desk or secondary entrance) and eliminate redundancy (e.g. avoid 2 steps admissions).
Impact on patient
- Less time spent in the site of care
- Easier & smoother journey
Impact on site of care
- Reduction of the idle time of the HCP for moving in the site of care
- Higher administrative requirements for nurses
- Optimised utilisation of HCP and rooms
Requirements
- Can require significant investments
- Can require activities at a broader scale than the practice at stake
- Requires dedicated analysis on the patient flow and physical journey
Optimised staffing approach
- +++ Physician-Time
- +++ Nurse-Time
- +++ Space
Changing the staffing mix to decrease overall cost of effort for taking care of patients (e.g. leverage junior nurses for post-administration observation of known patients, optimised frequency of physician consultations).
Impact on site of care
- Optimisation of staff utilisation & potential for additional capacity creation
Requirements
- Sufficient time-size and critical mass to allow for organisational optimisation
Efficient observation time planning
- +++ Nurse-Time
In a prolonged observation phase, the available free time can efficiently be used by the nurse to do additional work. E.g. administrative work. The nurse can also sit in the same room as the patient(s) - have a desk and just do some paperwork etc.
Impact on patient
- No continuous observation
- Observation based on frequent check-ups
Impact on site of care
- Optimised utilisation of HCP time
Requirements
- Nurse needs to be able to do frequent check-ups on patient
Joint patient observation
- ++ Nurse-Time
- +++ Space
For the maintenance phase of the treatment, set-up a dedicated room with the necessary equipment for administration and post-administration observation of several patients in parallel, in order to reduce the number of required HCP and room(s).
Impact on patient
- Lack of privacy during observation phase
- Potential incompatibility of patients during treatment (i.e. based on reaction to treatment)
- Patient more closely observed during the post-administration observation
Impact on site of care
- Optimised utilisation of HCP time
- Optimised utilisation of available space
- No exclusive observation
Requirements
- Availability of sufficiently large rooms at the site of care
Low-utilisation infrastructure
- ++ Space
The use of under-utilised infrastructure (e.g. specific times) of neighbouring departments (e.g. oncology).
Impact on patient
- Can lead to logistic challenges for patient
Impact on site of care
- Increases in capacity for patient care
- Optimised utilisation of HCP time
- Optimised utilisation of available space
Requirements
- Availability of low-utilisation infrastructure close to the practice
Site of care availability
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Tuesday
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Chairs
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Room 1
Nurse Timing
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Nurse 1
Nurse 2
Nurse 3
Physician Timing
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Physician 1
Physician 2
Physician 3
Chairs
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Room 1
Room 2
Room 3
Nurse Timing
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Nurse 1
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Nurse 3
Physician Timing
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Physician 1
Physician 2
Physician 3
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Room 2
Room 3
Nurse Timing
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Nurse 3
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Physician 3
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Room 2
Room 3
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Nurse 1
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Nurse 3
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Physician 3
Chairs
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Room 2
Room 3
Nurse Timing
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Nurse 1
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Nurse 3
Physician Timing
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Physician 1
Physician 2
Physician 3
Chairs
Chairs
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Room 2
Room 3
Nurse Timing
Start Time
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Nurse 1
Nurse 2
Nurse 3
Physician Timing
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End Time
Physician 1
Physician 2
Physician 3
Chairs
Chairs
Start Time
End Time
Room 1
Room 2
Room 3
Nurse Timing
Start Time
End Time
Nurse 1
Nurse 2
Nurse 3
Physician Timing
Start Time
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Physician 1
Physician 2
Physician 3
Site of care availability
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Rooms
Chairs
Room 1
Room 2
Nurses
Nurse 1
Nurse 2
Nurse 3
Physicians
Physician 1
Physician 2
Physician 3
Sessions
Session 1
Session 2
Session 2