Community Intervention Team – the role it plays in integrated patient centred care Noreen Curtin 6th October 2015

The role and purpose of the Community Intervention Team Case studies

A Community Intervention Team (CIT) is a nurse led health professional team which provides a rapid and integrated response to a patient with an acute episode of illness who requires enhanced services/acute intervention for a defined short period of time. This may be provided at home, in a residential setting or in the community as deemed appropriate, thereby avoiding acute hospital admission or facilitating early discharge.

The CIT provide a range of services including: Administration of home IV antibiotics (Out-patient Parenteral Anti-microbial Therapy -OPAT); Acute anticoagulation care; Acute wound care and dressings; Enhanced nurse monitoring following fractures, falls or surgery; Care of a patient with a central venous catheter;

Urinary related care; Care of the patient with a respiratory illness; Bowel care including ostomy care; Short term older person support and care Medication management/ administration

Location of CIT services October 2015

Care co-ordination at patient level – case study Background: J (man 31) Quadraplegia Living with his parents,supported with 12 hours of home support from Disabilities. Developed a pressure ulcer on sacrum which deteriorated resulting in osteomyelitis in saccral area. In-patient for 6 weeks.

Referral to CIT J was transferred to a Community Nursing Unit on discharge from UHL Referral to CIT for OPAT. His 12 hours of home support was transferred to the CNU and his own carers looked after him.

Service delivery Daily OPAT by CIT in the CNU Weekly bloods,PICC line care. Wound photography (with photographic consent) ed to Tissue Viability Nurse and Infectious Diseases consultant as he was unable to attend OPAT review clinic. Negative pressure wound therapy done by nursing staff CNU Peg feeding by own carers. Frequent liaison with parents, nursing staff, and Infectious Diseases team.

Patient outcome OPAT delivered for 9 weeks until wound healed. J was discharged to home from the CNU..

Chronic Disease Management Mr X - a 70 year old man with a 10 year hx of COPD. Increasing hospitalisation requiring IV antibiotics with referral to CIT for OPAT. Mar he expressed a wish to be cared for as much as possible at home. Care plan agreed with patient, family, respiratory consultant and CIT team. GP/ PHN informed Attend ED for diagnostics and until acute exacerbation stabilised. Mr X/ family contacted CIT when he presented to ED. CIT accepted his care.

6 referrals from ED in 2011 for home IV antibiotics 3 referrals from GP/ PHN in extra RGN/carer support required out of office hours, during periods of deterioration in his condition 5 self referrals, majority of which were at weekends. - nebuliser broken requiring urgent replacement - Other 4 occasions he felt unwell. CIT assessment completed; one occasion he required transfer to ED, the other 3 times, the CIT nurse contacted on-call GP to review him, he commenced oral antibiotics, steroids and had daily CIT visit until his condition stabilised.

Dec 2011 – continued deterioration CIT liaised with GP who referred him to the Community Palliative Care team CIT liaised with PHN who facilitated application for Home Care Package and hospital bed. Care plan agreed as Mr X reaches terminal stage of his disease. Collaboration with palliative care team, GP, PHN service, CIT and respiratory team.

Protocols and care pathways

Protocol details: Criteria for referral to CIT RAU discharge planning Referral and communication process Home visit Re-admission to hospital Training and equipment Service review procedure Appendices

Summary CIT - provides a rapid response and is accessible 8am – 10pm 7 days a week Flexible service designed around the patient’s needs Facilitated by communication networks and care pathways

Thank you