On behalf of COMMIT Team

Transcription

1 Dr Rashmi Sharma & Dr Achyut Guleri On behalf of COMMIT Team Quality Safety People Delivery Environment Cost

2 Consultant Microbiologist Clinical Director- Laboratory Medicine, Blackpool Teaching Hospitals and Hon. Senior Clinical Lecturer, University Central Lancashire Consultant Microbiologist: Lancashire Cardiac centre, Diabetic foot MDT clinic, COMMIT (OPAT) Special Interests: Clinical Mycology Patient safety, HAIs & Antibiotic stewardship QIPP transformational projects Antibacterial Resistance DISCLOSURES: Advisory board : MSD, Novartis, Schering Plough, Astellas, AstraZeneca Conference sponsorship: Novartis, MSD, AstraZeneca, Janssen-Cilag, Astellas, BD, Carefusion UK Lectures for: Bayer AG, MSD, Novartis, Pfizer, Astellas & BD Preparing teaching video: Astellas, BD Diagnostics

3 OBJECTIVES Blackpool OPAT Model a pilot in its 3 rd year The partnership structure Key achievements, Challenges, Future

4 Blackpool Teaching Hospitals Large Acute Teaching Hospital FT with contract for community health services for residents within a large geographical area of Blackpool, Fylde & Wyre Local population of 440,000 plus 12 million visitors Annual Budget 335M; employ 6000 staff Tertiary centre for Cardiac and Haematology 91,000 A&E attendances, 99,850 day case and inpatients and 295,000 outpatients 844 beds across five sites

5 BLACKPOOL: Hub of 12 million holiday makers in North-west England

6 BLACKPOOL, FYLDE & WYRE

7 Quality Safety People Delivery Environment Cost

8 Elements of Balance Clinician Clinical Care Management Savings P Value for Money CCG Commissioner Tax Payer Courtesy: Sharon Rourke, ex CCG Senior Commissioning Manager

9 Suitable patient for Home/Clinic administered IV therapy: Medically stable patient Any Infectious condition Requiring intravenous antibiotic Oral option: Non responsive or not optimal

10 COMMIT COMMunity/home Intravenous Therapy) Medically stable, any infectious condition, unresponsive oral or IV optimal option Diabetic Foot MDT Clinic GP referral GP led - Primary care Assessment Unit & ward 2 SUITABLE PATIENT Ward referral A & E referral Any other hospital referral [B, F, W resident] Hospital based: Consultant Microbiologist / ID PHARMACIST E-referral; 1 st Assessment; E-Management plan; E-prescription; Venous access (cannula/picc/mid); 1 st dose in pcau/ward; follow up appointments Community Clinic based: IV Nursing Team

11 COMMIT 1. Locally developed E-tools: E-referral (intranet & EMIS) E patient management plan E discharge prescription E Review & end of treatment report PMS (pharmamix) 2. Primary Care Centre Community based clinic offering IV abx (8am-8pm) CLINIC [30 appt slots/day] HOME [12 appt slots/day] 3. Multi-disciplinary team working: Clinic based IV nurse team with band 7 lead nurse Hospital team (Microbiologists, ID, pharmacist) Thursday MDT to discuss all patients 4. Branding & advertisement COMMIT; raising awareness for patients, GPs, wards, A&E 5. Regular steering committee & operational team meeting

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14 With permission of estates

15 5 IV stations 5 infusion stations

16 Mr. Y: A pleasure to attend, less like a chore and more like meeting friends. Mrs. X: P.S. the nurses are all lovely, nutters, but lovely!!"

17 Quality Safety People Delivery Environment Cost

18 April 14 March 15: 242 patients (aver 20.1 patients/month) Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

19 Bed Days Saved An average of >400 days/month Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Total Number of days of IV delivered outside of hospital

20 INFECTIOUS CONDITIONS (% of 242 patients) 2 2 CELLULITIS 8.3 BRONCHIECTASIS/AE DIABETIC FOOT / OM UTI/STENT IX DEEP/ORGAN ABSCESS 17.3 PJI/SA ENDOCARDITIS 5.3 MALIG OE

21 COMMIT STEERING GROUP BCN Flow Steering Group (every 2 wks) Better Care Now (BCN) Project Board (every 2 wks) BCN Alternative to Hospital / Bridge to Home Steering Group (every 2 wks) IV Therapy Steering Committee Membership Rehabilitation Working Group (weekly) Commissioning Manager NHS Blackpool CCG IV Therapy Working Group (fortnightly) Commissioning Support Officer NHS Fylde and Wyre CCG Acute Trust Board Executive Director & Director of Operations or DDOP Consultant Microbiologist COMMIT Clinical Strategic Lead Consultant Microbiologist COMMIT Clinical Operational Lead COMMIT Lead Nurse Antimicrobial Pharmacist Operational Lead - Head of Locality (Fylde and Wyre) Community Nursing and Rehab Therapies Better Care Now Programme Manager Better Care Now Project Support CIP DIRECTOR 1. Eliminating delays in care, 2. Ensuring we have the right professionals with the right skills to deliver high quality care and 3. Improving patient pathways.

22 Monitoring Performance - KPI Capacity Appointment Tracker: 12 home / 30 clinic slots KPI spreadsheet: Referral source, CCG B or F&W; Duration treatment; administrations, indication, clinic/home, outcomes, readmission Diagnosis, HRG code, HRG name, non-elective spell tariff (example below) Patient Feedback: COMMIT questionnaire; patient forum; consultant web-profile feedback from patients; DIAGNOSIS DESCRIPTION HRG code HRG name Non-elective spell tariff ( ) Osteomyelitis : Osteomyelitis HD25B Infections of Bones or Joints with CC Cellulitis : Cellulitis JD03B Intermediate Skin Disorders category 2 with Intermediate CC 3,000 1,301 Genito Urinary-UTI LA04F Urinary Tract Infection 1,372 Endocrine-Diabetes KA08Z Other Endocrine Disorders 1,778

23 PATIENT FEEDBACK & COMMENTS ON THE SERVICE = EXCELLENT TO VERY GOOD After many weeks in hospital, I was made to feel less like a patient and more like a person. Am self employed. If I would have been admitted to hospital, I would have been on benefits during the 12- weeks of treatment A very reassuring and professional service provided in comfortable and accessible surroundings. Without the IV team the only thing to look forward to would be more time as an inpatient. This service gives even the poorliest of people independence and the opportunity to be back home with loved ones P.S. the nurses are all lovely, nutters, but lovely!!"

24 Key challenges & future A pilot (commissioned) in its 3 rd year Phased nursing staff recruitment & training From Home only to Clinic and Home model Adopted by Trust PMO & Better Care Now in 2014 Sub-pilots in : Ferrinject, Frusemide, TPN, Infliximab, Immunotherapy, Bisphosphonates, Nurse led protocols for couple of uncomplicated conditions Challenges: satellite clinics; OPAT to OPT; Shifting Sands (federation of regional services, hospitals, etc)

25 CLINICIAN 1. All infectious conditions 2. GP & ward referrals 3. Consultant suitability assessment 4. Team working: Consultant Infection specialist, Pharmacist, Nursing 5. Weekly MDT 6. User friendly E-tools: referral, Prescription, Management/ monitoring plan, Review/end of treatment report, Clinical Care Tax Payer: value for money for a truly patient centred Value service for Savings Money MANAGEMENT 1. Better care Now Alternative to hospital Project 2. Savings QIPP/CIP 3. Early facilitated discharge 4. Closing beds; Reducing readmissions / avoidable admissions 5. Optimisation of bed use P PATIENT 1. Hospital, Community Clinic or home 2. Flexibility of appt (8am-8pm) 3. Prompt access to consultant care 4. 24/7 Helpline 5. Patient feedback, forum CCG commissioner 1. Aligned to NHS vision 2. Performance monitoring to ensure financially sustainable 3. Patient centred, quality care, Excellent patient feedback & press 4. Acute lead service delivery in community

26 CEO, Lead GP-Primary Care Assessment Unit, Pharmacist, COMMIT Nursing team, Microbiologists

27 There s no place like home