<abstract xmlns="http://www.w3.org/1999/xhtml"><sec><h3>Introduction</h3><p>Switching between clotting factor products is becoming increasingly common as product choice increases and financial pressure grows to choose the most cost-effective options. Guidance on carrying out the switch recommends a complex and long process that may benefit from being defined in a protocol. Haemophilia nurses may be responsible for managing product switches; anecdotal evidence suggests that clinical practice is variable.</p></sec><sec><h3>Aim</h3><p>To explore the role of specialist nurses in switching between clotting factor products and their use of a protocol.</p></sec><sec><h3>Method</h3><p>Nurses attending the 2018 World Federation of Hemophilia Congress were surveyed about clinical practice at their treatment centre and use of a protocol for switching clotting factor products.</p></sec><sec><h3>Results</h3><p>Of 192 nurses attending the conference, 49 nurses returned completed questionnaires, 45 of which were included in the study after exclusions. Responses were exclusively from economically developed countries. Almost all respondents (96%) had direct experience of switching. Half of those who responded to a question about protocol-based switching reported that switches were based on a protocol. When authorship was reported, the protocol was written by haemophilia nurses in about half of cases. Practice about blood testing to determine individual pharmacokinetic parameters prior to the switch was variable, but most nurses (86%) reported screening for inhibitors prior to switching. Respondents agreed to share their protocols among their peers, although only four were received by the research team.</p></sec><sec><h3>Conclusions</h3><p>Clinical practice in switching between clotting factor products is variable. Some nurses are switching treatments for patients without the supported of a written protocol, whereas others are involved in writing and implementing protocols. Sharing protocols is a first step in helping to establish best practice.</p></sec></abstract>

IntroductionSwitching between clotting factor products is becoming increasingly common as product choice increases and financial pressure grows to choose the most cost-effective options. Guidance on carrying out the switch recommends a complex and long process that may benefit from being defined in a protocol. Haemophilia nurses may be responsible for managing product switches; anecdotal evidence suggests that clinical practice is variable.AimTo explore the role of specialist nurses in switching between clotting factor products and their use of a protocol.MethodNurses attending the 2018 World Federation of Hemophilia Congress were surveyed about clinical practice at their treatment centre and use of a protocol for switching clotting factor products.ResultsOf 192 nurses attending the conference, 49 nurses returned completed questionnaires, 45 of which were included in the study after exclusions. Responses were exclusively from economically developed countries. Almost all respondents (96%) had direct experience of switching. Half of those who responded to a question about protocol-based switching reported that switches were based on a protocol. When authorship was reported, the protocol was written by haemophilia nurses in about half of cases. Practice about blood testing to determine individual pharmacokinetic parameters prior to the switch was variable, but most nurses (86%) reported screening for inhibitors prior to switching. Respondents agreed to share their protocols among their peers, although only four were received by the research team.ConclusionsClinical practice in switching between clotting factor products is variable. Some nurses are switching treatments for patients without the supported of a written protocol, whereas others are involved in writing and implementing protocols. Sharing protocols is a first step in helping to establish best practice.

Do nurses have the switch factor?

Clinical Nurse Specialist, Department of Haemostasis

Department of Paediatrics, Division of Oncology and Haematology

The Journal of Haemophilia Practice

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

{"article-title":"Do nurses have the switch factor?"}

IntroductionSwitching between clotting factor products is becoming increasingly common as product choice increases and financial pressure grows to choose the...

QUESTION	NUMBER OF RESPONSES (TOTAL=45)

Number of unique nurse responses (from individual centres)	45	UK	10
		USA	9
		Netherlands	6
		Canada	5
		New Zealand	4
		Ireland	2
		Sweden	2
		Australia, Croatia, Denmark, Finland, Germany, Romania, Switzerland	1 each

			NUMBER OF RESPONSES	% OF RESPONSES

Ever switched clotting factor product?	45	Yes	43	95%
Ever switched clotting factor product?	45	No	2	5%

Reason(s) for switch (more than one answer possible)	33^*	Clinical need	34
		Funder/purchaser changed product	30
		Patient request/preference	21

Was switch protocol-based?	40^*	Yes	20	50%
Was switch protocol-based?	40^*	No	20	50%

If so, who wrote the protocol?	24^*	Haemophilia team	15	62.5%
		Nurse/nurse specialist	4	16.5%
		Doctors	5	21%

Frequency of blood tests for pharmacokinetics before switch	26^*	Don’t know	1	4%
		No prior testing	6	23%
		Blood testing at least once	18	69%
		Depends on product	1	4%

Frequency of blood tests for pharmacokinetics after switch^**	25^*	None	4	16%
		Depends on product	4	16%
		Depends on clinical need	1	4%
		No/inappropriate response	16	64%

Screen for inhibitors before switch?	43^*	Yes	37	86%
Screen for inhibitors before switch?	43^*	No	6	14%

Was patient association involved?	43^*	Yes	11	26%
		No	27	63%
		Not sure	5	11%

Do nurses have the switch factor?

Article Category: Clinical Practice

Published Online: Nov 19, 2020

Page range: 129 - 135

DOI: https://doi.org/10.17225/jhp00162

Keywords
nurse experience, switching treatment, haemophilia

© 2020 Greta Mulders et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Summary of questionnaire responses

Do nurses have the switch factor?

Article Category: Clinical Practice

Published Online: Nov 19, 2020

Page range: 129 - 135

DOI: https://doi.org/10.17225/jhp00162

Keywordsnurse experience, switching treatment, haemophilia

© 2020 Greta Mulders et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Summary of questionnaire responses

Keywords
nurse experience, switching treatment, haemophilia