The OPAT experience in North Staffordshire

Neena Bodasing

The OPAT Experience in North Staffordshire

Dr Neena Bodasing

• UHNS - one of the largest and busiest hospitals in the country with > 1,200 beds and around 6,200 whole time equivalent (WTE) employees

• Caring for over >600 000 patients a year• Offering specialised services to over 3 mill• £300 million modernisation scheme• Large geographical area with high levels of

deprivation

Dr Neena BodasingID Consultant Lead

Barbara WhiteClinical Nurse specialistLead 1.0

Joanna WhittakerClinical Nurse Specialist0.8

Dr Tony CadwganConsultant

Dr Vasile Laza-StancaConsultant Microbiologist

The OPAT Team - who we are

We are supported by -

Jackie YatesPharmacist

Clinical Photography Dept

1.8 specialist nurses based in UHNS 9-5 7 days a week 365 days per year

Patients referred from all areas of Acute Trust GP referrals directed to A and E then OPAT referral Nurse led clinic available for OPAT patient review –

based on ID ward Weekly ‘virtual ward round’ with all the team

What is the pathway?

Who receives OPAT?

Who receives OPAT?

Numbers Treated

0

50

100

150

200

250

2009/10 2010/11 2011/12 2012/13 (April-August)

Age Groups

What we Treat and What with

Condition (not exclusive)

Drugs Used

Bacteraemia Ertapenem od, Ceftriaxone od

Respiratory BronchiectasisExacerbation COPD

Ceftazidime bd, Ceftriaxone bd/od

Orthopoedic / osteomyelitis Infected JointInfected wound

Teicoplanin od/ 3x week

Neurosurgery Infected woundDiscitis

Ceftriaxone bd, Teicoplanin od

Cellulitis / soft tissue injury Ceftriaxone od, Teicoplanin od

Meningitis Ceftriaxone bd

Renal / UTI ESBL, Pseudomonas Ertapenem od, Ceftazidime bd

TB/ Mycobacterium infections

Amikacin od, Capreomycin

Endocarditis Infected ICD/PPMEndocarditis

Daptomycin od, Teicoplanin od

2663 bed dayssaved over last financial year

In-patient days saved

Patient satisfaction

• 53% return• 99.8% of those

describing the service as excellent

• 2.55% re-admission rate• (20% non-OPAT related)

Setting up OPAT – the process

Feasibility study – 2003 to 2004 24 patients, 92% willing and suitable, >100

potential bed days saved Business case – 2004 to 2005 Pilot - 2006/7 Service – 2008 to present time

Model Hospital-based, small number of specialist nurses,

under care of Infectious Diseases consultants

BUT Existing and under-utilised intermediate care

service with community-based nursing teams No suitable clinical area in ID ward Hospital and community “arms” of OPAT - started

as pilot and expanded

Challenges

Moving Goalposts

Initially emphasis on maintaining tariff for admission

Subsequently emphasis on admission avoidance

Bed days saved = beds closure?

Patient satisfaction – a priority?

Outcomes

Two Primary Care Trusts

Wanted different models of care

Only one PCT funded OPAT

?post code service Differing skills of

community service in each PCT

What didn't work

Repeated meetings with “key-stakeholders” Identifying key stake-holders Changing staff Misconceptions re OPAT (eg all patients on IV

antibiotics suitable for OPAT) Presentations to medical staff

What did work

Easy referral process Patient hand-held notes (photocopies) Monthly meetings between hospital and

community teams Patient letters of support Real time data and audit (“red legs”) Nice staff = great patient satisfaction data

What did work

Weekly/monthly email to key-stakeholders -1 line!

OPAT on agenda at Trust infection control meeting

Nurses visiting key areas (A & E, Ortho clinics, medical wards)

OPAT within hospital guidelines on cellulitis Patient satisfaction survey presented at

service user meetings and Trust Board

How does the UHNS OPAT model differ from other services?

Use of existing district nurses allows patients to be treated in their own homes

BUT training issues Use of clinical photography to complement

hand-held notes in cellulitis cases Combination of midlines, Hickman lines,

venflons and butterfly

Vision OPAT team based in clinical area taking direct GP

referrals in addition to hospital referrals Integration into other ambulatory care services Offering patient choice of

Inpatient care Treatment at home

Daily OP care – with review by ID team

3 hospital-based nurses who rotate into community New IRLS (Integrated Red Leg Service) Self administration

Self - administration• Carefully selected patients• Training period• Robust follow-up

• Only two patients so farbut increasing experienceand confidence• Empowering patients and

decreasing costs

Questions?