The pitfalls and joys of establishing a community OPAT service Helen Forrest The pitfalls and joys...

The pitfalls and joys of establishing

a community OPAT service

Helen Forrest

The Pitfalls and Joys of establishing a

Community IV Therapy Service

Helen Forrest - SEQOL

Assignment

• Business case for Community IV Therapy Service– Aim – Predominantly to prevent

hospital admission, also to facilitate earlier discharge by providing an effective Community based Intravenous Therapy (CIVT) service

Assignment• Connect with SEQOL vision• Innovative Model of delivery • Equal to inpatient care if not superior• Demonstrate benefits to stakeholders patients,

commissioners and why winning formula• Where CIVT will operate• How will we get there• Time frame • based on three conditions

– Cellulitis– Pneumonia– COPD

• ASAP• No service specification

Supporting people to make the most of their life

Passionate about PeopleWorking together, as one

Valuing individuals and communitiesInspiring ourselves and others

Within existing resources

SEQOL IV Therapy Project LeadWHY ME?

• ICN• Not giving IV Therapy• No ‘Hands on’ 13 years

• RCA’s MRSA bacteraemias highlighted concern around IV therapy management

• Implemented ANTT - Aseptic None Touch Technique• IPS IV Therapy Forum• Lower Limb Cellulitis Pathway – AA pilot• Passion for patient safety issues• New ways of working

Backdrop of new organisation and period of rapid change

Stakeholders

• Identify important customers internal and external

• Opinion leaders on side• Early meeting to get opinions,

understanding of complexities of challenge and buy in

Project team

• Lead inc IP&C• Clinical lead• Director Operations• Director Finance• Professional Nurse Lead• HR• IT • Governance• Risk manager• Community Nurse Lead• Practice educators• Discharge Liaison• GP• OOH

• Microbiologist• Pharmacist

Partnership working with Acute Trust

Within SEQOL Not within SEQOL

Determine model of service

Plan

• Criteria from other organisations – service specifications

• How other teams deliver services• Contacted nurse specialists• Networking

– IPS IV forum– study days– OPAT – BC Toolkit– NIVAS –– Pathways workshops research guidance

• Lack of experience• Shift of activity from acute to community• Funding and resources• Identifying numbers of patients• Difficult to predict number of avoided

admission • Coordinating hospital and community care• Clinical accountability• Ensuring patient safety and outcomes• Risk management

Vision

Current activity

Via SPA & Acute

Trust

Comprehensive

IV Therapy service

Home Work

Day unit

Nurse led specialist

team

Self administrati

on

Integrated

community and acute team

Integrated VAD insertio

n services

Year 1 Year 5

Community IV Therapy Service

Build it and they will come

Current position

IV therapy contacts

April -Sept 2011

0

20

40

60

80

100

120

140

160

180

April May June July August September

Month

No

. of

visi

ts

• majority of IV therapy is currently provided by the DGH

• some patients referred to the community nursing teams, mostly patients requiring long term IV antibiotic therapy via a central line

• other IV medications are administered on a patient by patient basis ad hoc (SPA)

753 visits to 103 patients

Local experience

• Swindon has strong association with manufacturing and railways

• COPD largest cause of non elective admissions• Quality Outcome Figures 2006-2007 of 1.5% of the

population put the PCT above the national and SHA ratings• Some patients with long term conditions are currently

managed at home using Telehealth. • These patients are being admitted unnecessarily for

intravenous therapies. • Audit has demonstrated that during these admissions there

was a reduction in the patient’s independence, increase in infection, loss of time and quality of life which could have been spent at home.

• Some patients refuse admission

Based on Halton and St Helen’s

Model of delivery

Expected outcomes• Better faster patient centered timely equitable care• Improved patient experience.• Improved clinical outcomes including reduced risk of acquiring

HCAIs• Reduction in admissions for IV therapy.• Promote early discharge.• Reduction in length of stay.• Reduction of admissions (LTC & telehealth patients)• Reduce burden on community nursing services.• 90% of patients referred into the service are offered treatment at

home or CIVT day unit

Joys

• They said YES• Opportunity to really improve patient

experience• Great learning experience• Job satisfaction - motivation• Team work• Partnership working• SEQOL = income generated goes back

into services • Patience

Next steps

• Get the money in the bank• Recruit specialist nurses• Detailed implementation plans• Pathway, policy, protocol development • Marketing the service• Pilot – evaluate• Refine• Fully implement• Evaluate

Future• Determination to secure future funding• Develop the service

Community IV

Therapy Service