Commissioning a Community IV service

Transcription

1 East & outh East England pecialist Pharmacy ervices East of England, London, outh Central & outh East Coast Medicines Use and afety Commissioning a Community IV service East and outh East of England pecialist Pharmacy ervices Medicine Use and afety Division East & outh East England pecialist Pharmacy ervices Dec 2013

2 Community IV services Medicines Use and afety Varied configurations: Community (OPAT) specialist IV team Vs District Nursing team Integrated or stand-alone organisation Rough guide to Community Health erviceshttp:// E-and-E-England/Meds-use-and-safety/Leadership-workforce/Resources-supportstaff/The-Rough-Guide-to-Community-Health-ervices-Vs3/

3 ervice pecification Medicines Use and afety Often non-existent for community IV service hould describe MDT approach to care pecialist IV nurse ID consultant pharmacist Describe the referral criteria?

4 ervice pecification Medicines Use and afety Consider Who is doing the prescribing? What documentation is used? how communication/review will happen? Virtual ward Face to face meetings Operational meetings

5 ervice pecification Medicines Use and afety Consider Clinical governance arrangements process and record keeping Incident reporting and learning Monitor quality outcomes as well as activity

6 ervice pecification Medicines Use and afety Consider options appraisal for: ource of drugs, diluent and flush tock, acute or community pharmacy supplied? Ready to administer? ource of consumables tock or acute supplied?

7 Community Pharmacy supply for IV Medicines Use and afety May be suitable for primary/community based service Little experience of IV therapy Delay in obtaining stock olution may be to designate particular pharmacies that can develop the knowledge and skills and maintain a stock

8 Useful BAC Resources Medicines Use and afety OPAT Best practice recommendations ull.pdf+html OPAT Business Case Toolkit OPAT Patient Management ystem

9 P Recurrent costs Include: Nursing care Drug costs Medicines Use and afety Medical care Pharmaceutical care Flush and diluent Consumables Pathology Other costs: overheads, travel, staff training etc.

10 Medicines Use and afety WORKHOP

11 Who pays? Medicines Use and afety Clinical Commissioning Groups Acute inpatient care Outpatient care (unless specialised commissioning e.g. HIV) Community Care

12 Payment by Results (PbR) Medicines Use and afety Currency for admitted patient care - HRGs HD25A Osteomyelitis without complications or comorbidities. Trim point is 69 days PA17B Cellulitis. Trim point is 5 days Covers admission to discharge Excess bed days Also currency for outpatient care TFCs

13 How is activity funded? Medicines Use and afety INPATIENT PbR Tariff Acute OPAT Local Tariff? Within PbR Tariff? COMMUNITY IV Within block contract? Locally commissioned?

14 Example: IV treatment of cellulitis Medicines Use and afety 2 days 1 day Hospital HRG funds for 5 Days (trim point) ++ excess bed days? Local tariff for OPAT Community Block contract

15 Early Discharge Medicines Use and afety OPAT = half the cost of inpatient However, commissioners could be paying 3 times over? And more: Increased capacity in the acute for additional activity and income Increased costs in primary care e.g. pathology or prescribing??

16 till a good idea? Medicines Use and afety Hospital acquired infections Patient experience Patient choice tart smart then focus and it is cost-effective

17 Admission avoidance Medicines Use and afety Examples are uncomplicated UTIs or TIs. Primary and community based teams e.g. Rapid response teams Readmission avoidance

18 Admission avoidance Medicines Use and afety Ambulatory care pathways or BPTs e.g. JD03A for cellulitis Care pathway from outpatient clinics More efficiency gains financially favours community service

19 Conclusion Medicines Use and afety Understanding the funding flows will help clinicians to develop a safe and sustainable community IV service More efficiency gains if you can deliver reduced LO and admission avoidance MDT working and collaboration are a must do

20 Medicines Use and afety