Community IV Therapy: Avoiding hospital admission and facilitating discharge Linda Nazarko Nurse consultant Ealing Hospital NHS Trust
Aims and objectives To enable you to: Be aware of the benefits of OPAT Be aware of the range of services provided Types of therapy Selecting patients and monitoring outcomes Understand the needs of those requiring short and long term therapy Be aware of how to tailor services to meet needs Demonstrate benefits to commissioners
OPAT, past present and future Outpatient Parenteral Antimicrobial Therapy (OPAT ) now used to describe IV therapy outside inpatient settings Developed 1974, for children with cystic fibrosis First described UK early 1990s
Components of an OPAT service
The OPAT team Physician- IDT consultant Microbiologist Pharmacist with expertise in antibiotic therapy Nurse specialist Community nurses Administration support
Selecting patients Clear criteria Inclusion and exclusion criteria Regular reviews mandatory Review frequency determined by condition
Inclusion/exclusion criteria (an example)
Service delivery models
Self administered outpatient antibiotics therapy (S-OPAT) Self-administration of intravenous antimicrobial therapy, in selected patients under the supervision of a specialist team, is a safe and feasible strategy (Barr et al, 2012a) Between 38-53 percent of patients can self administer
Infusion centres H-OPAT Cost effective Can be based in community hospitals, clinics or acute hospitals Can be used to teach patients and staff, deliver therapy, check bloods, monitor patients Patent have to travel but less delay in waiting for staff Drop in for problems
Home (community) C-OPAT Around 70 percent of those treated in hospitals suitable for OPAT in some form OPAT was generally safe and effective, but specific patient groups were identified with more complex management pathways and poorer outcomes (Seaton et al, 2011) Specialist IV teams Community nurses Private companies
Types of therapy Antimicrobials. Chemotherapy. Bisphosphonates; Iron sucrose; Immunoglobulins; Parenteral nutrition (PN); Blood products Intravenous fluid
Short and long term therapy
Emma s story Delivered by emergency caesarean section and returned home with baby. Developed post operative infection, admitted and potentially separated from her baby whilst having IV antibiotics. Distraught and desperate to go home
Marek s story Came to UK from Poland and is supporting a wife and two children. Has multidrug resistant TB. Needs oral antibiotics plus daily IV antibiotic therapy for at least six months. Keen to S-OPAT but worried he will not manage. Fearful that he will lose his job if he is late or has a lot of time off
Meeting patient needs
Antimicrobial therapy Third generation cephalosporins High risk C. Difficile in hospital but not in community Daily or occassionally twice daily therapy
Developing and supporting staff Staff training in IV therapy Learn how to use VADs used in OPAT RCN Standards guidance Nurse specialist and OPAT team support
Delivering a comprehensive service Use existing services But don t overwhelm them Build on services Tailor services to meet needs Community for housebound, rapid response for short interventions and infusion centre to enable and empower those needing long term OPAT
Business case and KPIs British Society for Antimicrobial Therapy (2011). Outpatient and Parenteral Antimicrobial Therapy (OPAT) Toolkit for Developing a Business Case for OPAT Services in the UK. BSAC, Birmingham. http://e-opat.com/wpcontent/themes/pmix/business_case_toolkit_ PDF.pdf
Evaluate outcomes Use existing information routinely gathered Quality tools e.g. productives series Additional questionnaires, interviews, audits
What to evaluate Clinical and patient outcomes Service specific e.g. number of admissions prevented, bed days saved Improvements in functional status Patient satisfaction Productivity and efficiency Staffing indicators
Why evaluate Services change over time and we may be too busy to notice We need to learn what we can improve We may identify gaps and opportunities to develop
Cost effective services Get accurate costs of services Not just cost but also: Accessibility, care closer to home Timely no long waiting lists Relieving pressure on traditional services Meeting or exceeding quality indicators
Being excellent is not enough You need to be seen to excellent Be visible Evaluate and innovate Disseminate Move forward You are stars let your light shine brightly
Final tips Up to 70 percent of inpatients could benefit from OPAT Around half of those having OPAT could self administer The way we provide IV therapy is changing and demand for OPAT will increase OPAT enables people to go home or stay home OPAT is safe, cost effective and demand will increase
Thank you for listening Any questions?