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The OPAT experience in Dudley
Kate Owen & Nichola Hughes-Gordon
Dudley Group of HospitalsOutpatient Intravenous Antibiotic Therapy
Kate Owen (District Nurse Specialist Practitioner)
Nichola Hughes-Gordon (Acute medical nurse)
Dudley OPAT Service
• Joint project between hospital and community staff
• Launched in January 2012
• Replaced the original community IV model for treating cellulitis
Dudley OPAT ServiceThe Team:
Hospital Staff• Acute Medical Unit consultant and registrars• Acute Medical Unit nurses• Pharmacy• Microbiology
Community Staff • Virtual IV team of community nurses• Community clinic• Advanced Nurse Practitioners and senior nurses with NMP
Policies and Pathways
Overarching OPAT policyStrict inclusion criteria
Ratified specific pathways for: Cellulitis, Complex UTI (including ESBL and pyelonephritis)
Development of new pathways:Diabetic foot ulcer and osteomyelitisBronchiectasis and pseudomonas chest infections
Future pathways Discitis, Septic arthritis, Infective endocarditis,
PerformanceSince January 2012,
Over 700 bed days saved, more capacity in hospital
Over 90 patients treated with high level of patient satisfaction, only 2 patients readmitted
IV team contacts
0
20
40
60
80
100
120
140
160
January February March April May June July
Series1
DiagnosisDiagnosis
65%
25%
10%
Cellulitis
UTI
Other
A Patient Journey – hospital Patient diagnosis
confirmed and needs
IVAB
Referred toOPAT Hospital team
Patient cannulatedFirst dose of IVAB
administeredTTO prescribed
Referred to Community
Nurses
Patient journey continues in the community Accepted referral
by community nurse
Patient housebound
Patient receives IVAB
Bloods taken day before review
Patient reviewed community or hospital clinic
Patient continues treatment or discharged
Patient can attend clinic
Success!Transferring community nursing services to the acute trust has strengthened the working relationship between community and acute care
Excellent example of acute and community working together to benefit patient care, reduce hospital admissions and facilitate early discharge
Support from senior management and AMU consultants
Project management team set up with key professionals to develop policy and clinical pathways
Enthusiastic, “can do” attitude
Patient SatisfactionA survey was sent to patients and we received a 43% response rate
100% stated they were satisfied with the service
The level of support during treatment was rated as excellent by 71% of respondents and 29% stated it was very good
“All the staff were brilliant at their job and always took time to talk”
ChallengesEmbedding the referral process for OPAT
Communication to all of the staff on EAU / ward nurses / doctors
Vascular access for some patients however the use of PICC, Tunnelled Central Lines, Midlines and Winged Infusion Devices has helped
Future ChallengesFurther pathways
Further education of all staff
IT challenges – database, electronic authorisation and recoding administration of doses
Funding for the future – business case
Increasing capacity within the community
Developing advanced nursing skills and NMP
What we have learnt so far
• Communication is keyRegular meetings and updates with the OPAT team, to the patients and relatives, and to other staff members within the hospital and community setting
•Keep the team small: experienced, regular team members
•Keep building upon the success: new pathways
•Ensuring constant feedback: boost morale, high levels of patient satisfaction and reduced number of bed days.
Conclusion
Excellent working relationship between hospital and community staff
Safe working, pathways developed, success going from strength to strength!