OPAT in the community Paul Jhass

The Kent IVs in the community experience (holistic nursing care with enhance IV capabilities) Paul Jhass Project Lead and Advanced Pharmacist

The changing NHS environment requires healthcare provision that offers high quality patient focused care and that which reduces waste and inefficiencies. District Nurses with their Community hospital colleagues are well placed to provide a defined IV service within the context of their daily work. Introduction

…… in Kent The District nurses unique workload and patients complexities means that a very cost effective and an efficient 24/7 patient care involving IVs is being offered by nurses. This is integrated care as opposed to a piecemeal approach. The design of the service delivery model in the community is imaginative to accommodate a large population with several acute and tertiary hospitals as well as CCG referrals. The lack of objective data and coding makes it difficult to determine budgets and appropriate competent staffing requirements for patients requiring IVs with complex chronic disease management in the community setting.

The Service model – enhancing District Nurse capabilities to accommodate Early discharge Collaborative working with the Acute Trust clinicians and nursing teams and Hospital OPAT service where these exists. Admissions Avoidance Care pathway based disease specific which involves GP and the Acute Trust team. Just the administration of IVs and line management Tertiary Centres and their service delivery model

1.5 IV nurse specialists with a Pharmacist 5 (+) Clinical Leads 45 IV link nurses 3500 community nurses – bases within GP surgeries and community hospitals, and in-reach nurse at the Acute Trusts 24/7 Pharmacy team support 12 Community Hospitals - for early discharge (and fixed centres for ambulatory patients) A 24/7 plus IV Service

Patient selection – by the Acute team pertinent to our capabilities Acute team – role and responsibilities Risk Assessment – extension to NPSA 20 Injectables Risk Assessment Any patient on any antibiotic with a ‘carepathway’ Minimum data set Clinical responsibility, ongoing monitoring and reporting Supply – medicines and consumables Types of Patients

Kent Data April 2011 to August 2012 patients contacts 13,950 Activities include: 1.Administration of IV antibiotics and patient monitoring requirements 2.Line flushing 3.VAD management 4.Removal of Picc line Disease areas: 1.Cellulitis 2.Orthopaedic 3.COPD 4.Endocarditis 5.Neurosurgery 6.Others

The KCHT IV service - ongoing work To identify and address issues an objective evaluation tool is being developed to assess acuity and productivity. NPSA Risk Assessment - pro forma 4 requires refinement CVAD trouble shooting and management Competencies and capabilities framework Education and training with University of Kent A well integrated routine standardised service delivered by majority of nurses

Challenges Bed closures – OPAT as revenue generator for the Acute Trust Achieving Integrated and partnership working with other NHS Trusts Independent providers – cherry picking with a singular focus Working with several and variable Acute Trust and their individual arrangements Discharge process CCGs and the commissioners direction of travel The NHS itself

Conclusion To date – Service up and running, and delivering – Competencies framework – Education and training delivered locally for the different levels Refining Service delivery model that is effective and efficient and keeping it within the NHS

Opinion The optimal OPAT services need to be delivered by integrating with community nurses : The whole patient approach – example diabetic infected foot patient. Network need to be established and working for patient benefit 24/7. No trending no contracts. Districts nurses are worthy of investing in to sustain a holistic patient centred service. It is in the best interest of the patient to have a minimum number of healthcare professional from a minimum number of agencies to delivery their IVs in addition to their existing care.

Declaration Nothing to declare – no conflicts of interest !

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