Dan Clutterbuck Consultant GUM March 2013 Lothian ICP for HIV Dan Clutterbuck Consultant GUM March 2013

Lothian Situation Two clinics providing HIV care GUM Clinic (Chalmers) Infectious Diseases Unit Different models of care Combination of data recording systems Paper notes/ proformas In-house database TRAK (RIDU) and NaSH (Chalmers)

Process Initial meeting 9th June 2010 Options considered ICP for diagnosis Chronic treatment (outpatient visits) Starting therapy Acute admissions Start with an ICP for diagnosis In parallel with national ICP developments

ICP for first 3 months of care 20 individuals on ICP team Process mapping in both units Draft ICP pre-piloted with 10 individuals, redrafted late 2011 1 year pilot commenced April 2012 15 formal meetings to date, 2 team ‘brainstorming’ sessions ICP facilitator support on a voluntary basis

Results 55 of 63 newly diagnosed or transferring in HIV patients completed the ICP by February 2013 (37/40 in GUM and 18/23 in ID) Of 24 essential items a mean of 16.8 in ID and 19.9 in GUM were completed overall. Completion of fields was high for sexual health in both units (53/55 overall) and lowest for ‘Plan for out of hours care’. 

Variance recording Variances were well recorded for ‘Consent to GP disclosure’ (Not completed in 17, variance recorded in 12) but less well for ‘cardiovascular risk assessment’ (Not completed in 37, variance recorded in 15). Completion was not 100% even for items identified by the clinical team as essential (e.g. STI screen; not completed in 15, variance recorded in 9)

Learning Different processes make single document a challenge (inpatient medical vs outpatient multidisciplinary models) Nursing team drive forward use/completion Numerous system and clinical questions arise in development New patient review meeting Annual review process and patient choice Standard legal/transmission information

Next steps Planned/Unplanned visit documentation introduced in Chalmers Jan 2013 Decision to incorporate Annual Review documentation into Access database Move to electronic record when complete Flexibility in timing of completion of different elements Development of patient questionnaire

Next steps Collation of data from 1 year pilot Submission of poster at ICP conference Feedback day to clinical teams July 2013 Agree 5 priority areas for 100% variance recording Incorporation of data and variance recording in local database Patient questionnaire Patient views on pathways, delivery, processes

Database

ICP form

Variance recording

Thank you ICP Team David Wilks, Alan Wilson – HIV Database Linda Panton, RIDU HIV nursing Alan Fisher, NHS Lothian ICP support Hosanna Bankhead, THT/HIV Scotland- patient/user representative