The OPAT experience in Nottingham Tim Hills

The OPAT experience in Nottingham Tim Hills, Sue Snape, Amanda Bort

Background and upto April 2011? Nottingham University Hospitals Acute Teaching Hospital over two main sites ~1700 beds Current services Cystic Fibrosis; Admission Avoidance – for 80 patients in 2010/11 – 1906 bed days Infectious Diseases Service IV Infusion centre model – 4 patients per day capacity. 2010: 20 patients, 341 bed days. Aim Set up ID led OPAT service to orthopaedic and diabetic patients using the patient self-administration model.

How to get the local data…Every Trust wants a feasibility study for their local hospital (Winchester)

How to get the local data…Every Trust wants a feasibility study for their local hospital Q4. What date could OPAT start/ have started? ____________________________________________ Q5. Could the patient give their own ivs? Yes □ No □ Q6. Would the patient need a HCW to administer ivs? Yes □ No □

Funding Process – Feasibility Study Orthopaedics In 18 weeks 45 patients suitable for OPAT programme. Total 829 bed days annualises to 2395 bed days/year or 6.5 beds/year. 25 likely to self administer = 382 bed days in 18 weeks This annualises to 1103 bed days/yr or 3 beds/year Diabetes In 15 weeks 25 patients suitable for OPAT programme. 17 patients discharged - 499 bed days, annualises to1729 bed days/year or 4.7 beds/year. Plus 8 patients who are still inpatients, bed days saved not determined. 9 patients (out of 17) Likely to self administer –258 bed days This annualises to 894 bed days/yr or 2.45 beds/year

What did we do whilst waiting for nurses? Visited other services. Paperwork!! Patient held record Patient information pack HCW information pack, consent form, competency assessment, competency assessments, OPAT prescription

Funding Process – Pilot Oct ‘11 – March ‘12 Reablement bid 2 nurses for 22 weeks (1 WTE Band 7 and 1 WTE Band 6), to teach self/carer-administration– Costing £75,000 per annum Pharmacy and Consultant time unfunded In T&O we saved 1009 bed days which annualises to 2384 bed days/year – or 6.5 beds/yr. Total 1608 bed days saved (T&O + Diabetes 1431 bed days)– equivalent to 3800 bed days/year or 10.41 beds/year

OPAT Service Pathway Review Teaching Assessment Patients referred to OPAT team Case Accepted by consultant Assessed and taught by OPAT nurses using competency based package Daily attendance ID ward Discharged to self (partner/relative) administer All patients reviewed at the Tuesday Virtual OPAT ward round Bloods/TDM checked Treatment plans made Prescriptions written by IP pharmacist New referrals discussed Clinic Review Thursday Consultant sees new patients and problems, OPAT nurses see all patients, medication ready for collection.

Governace Quarterly meetings Compliance to national standards Approve/review paperwork Take stock of the service Compliance to national standards Review Outcomes Jan-Mar Apr-June Patients Treated 40 36 Completed full treatment in the community with cure/ improvement 90% 83.3% Overall line complications 10% 0% Antibiotic allergy/ reactions 20% 11% Readmissions (reasons below) : 20.0% 11.1% Treatment failure 2.5% 2.8% Line problems 5.0% 0.0% Antibiotic reactions 7.5% Unrelated admissions 5.6%

Pharmacy Issues Standardise IV administration TTO quantity sheet for pharmacy, helps with stock levels in dispensary.

Pharmacy Issues Antibiotic Allergies Teicoplanin Patients admitted as day attendee to receive/be taught new regimen. Teicoplanin Levels at day 5 may increase further routinely checking day 7-8. Outpatient VAT savings Uncompounded drugs generally too cheap for external homecare advantage. Internal social enterprise? Fridge Temperatures/monitoring – Daptomycin

OPAT from a nursing perspective. Considerations before starting Create a clear referral pathway before the service is launched. Ensure basic needs for service are in place Computers, mobile telephones/bleeps, out of hours cover and consider lone working early for home assessments. Support from Outpatients and launch wards/areas. Consumables , 4 weeks supply of equipment will not be readily available from ward areas. Spend time with other services ,why reinvent the wheel. THINK BIG IT WILL BE BIGGER THAN YOU COULD POSSIBLY IMAGINE.!!!!!Have a rough idea of service development from the offset.

Next steps…. The phased introduction of a Trust-wide OPAT service Pre-compounded drugs for patients unable to mix their own Reablement bid for Health care worker administered Admission avoidance Cellulitis for ambulant patients – currently working with ED/Acute Medicine and Plastics to develop a pathway – infusion centre model Infected Bronchiectatic patients Other specialities Spinal surgery – Spinal infections Cardiology - Endocarditis ENT – Malignant Otitis Externa Respiratory - Infected exacerbation of Bronchiectasis Vascular infections

Current Team Transitional Bid funded: OPAT Band 7 Nurse, OPAT Band 6 x2 Nurse, OPAT Band 2 HCW, Pharmacy Band 5 technician 0.2WTE 0.15WTE Pharmacist Band 8b Consultant 3PA +1.5PA 1st 44 weeks we have saved 3404 bed days – which annualises to 4021 beds/yr – which equates to 11.01 beds/yr

Thankyou