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

The OPAT Team - who we are Joanna Whittaker Clinical Nurse Specialist 0.8 Dr Vasile Laza-Stanca Consultant Microbiologist Dr Tony Cadwgan Consultant Dr Neena Bodasing ID Consultant Lead Barbara White Clinical Nurse specialist Lead 1.0

We are supported by - Jackie Yates Pharmacist Clinical Photography Dept

What is the pathway? 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

Who receives OPAT?

Who receives OPAT? Numbers Treated Age Groups

What we Treat and What with Condition (not exclusive) Drugs Used Bacteraemia Ertapenem od, Ceftriaxone od Respiratory Bronchiectasis Exacerbation COPD Ceftazidime bd, Ceftriaxone bd/od Orthopoedic / osteomyelitis Infected Joint Infected wound Teicoplanin od/ 3x week Neurosurgery Discitis 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/PPM Daptomycin od, Teicoplanin od 9

In-patient days saved 2663 bed days saved over last financial year

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 12

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 13

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 15

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 16

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 17

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 18

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 19

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 21

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

Only two patients so far but increasing experience and confidence Empowering patients and decreasing costs

Questions?