1. The Lung Defence Home IV Antibiotic and Ambulatory Care Service Karen Henderson Clinical Nurse Specialist

2. Bronchiectasis/recurrent respiratory infections 2013/14 1375 2014/15 1566 2015/16 1728

3.  The Lung Defence Home IV Antibiotic SIP: Pilot October 2013-October 2014  Patients with non-CF Bronchiectasis/recurrent respiratory infections requiring intravenous antibiotics

4.  Provide a safe, cost effective and efficient treatment option for patients to learn how to self-administer antibiotics at home  Reduce hospital admission and provide treatment in an elective planned timeframe Patient Reduce waiting times Reduce risk associated with admission Improve cost efficiency Facilitate self-care self- management

5. 1 Community based training: Self-mixed IV antibiotics 2 Hospital Day Case admission: Pre- mixed IV antibiotic training 3 Hospital Day Case admission: Self- mixed IV antibiotic training

6. Community based training Self- mixed antibiotics Day case admission Nurse home visits until D4 Outpatient review D7 and D14 Suitable for patients within 30-40 minutes drive of Papworth Exclusion criteria Pre-mixed antibiotics Home care delivery Day case admission Outpatient review D6 and D15 Suitable for patients >40 minutes away or for those unable to self-mix IV antibiotics Exclusion criteria

7. Pre-Mix IVsSelf-Mix IVs

8. Home IV Pilot 2013-2014Home IV Service 2015-2016

9. Home IV Training Programme

10. Home IV Referral Clinic / LDC Telephone support service Pre-mixed or self-mix Home IV Nursing Team contact the patient by phone Discuss training process Identify Venous Access Requirements Plan day case admission Organise Prescriptions Homecare delivery for Pre-mixed IVs

11. Eclipse device Pre-filled syringes Fridge supplied for storing medication

12. Intensive training Second dose administered by patient First Dose Administered Monitor Day Case admission IV Access Follow up arrangements Day 7 & 14 Review Final Nursing Assessment Patient /carer are confident and competent Specialist Physiotherapy Assessment Patient education Review of techniques

13. Self-management of Home IVs Patient Engagement Robust training and Education Communication Information Accessible support

14. Patient Local Pharmacy home care Direct access to Home IV Nursing team Out Of Hours PRINCESS WARD Telephone Support Line Patient Support Mechanisms

15. Clinical Monitoring Process Medical Assessment Nursing Assessment Physiotherapy Response to treatment Adverse reaction/tolerability Response to treatment Adverse reaction/tolerability Venous Access Monitoring bloods Support & Education Venous Access Monitoring bloods Support & Education Airway clearance Patient education Nebulised antibiotic challenge Airway clearance Patient education Nebulised antibiotic challenge

16. Princess Ward Ambulatory Care

18. Patient Satisfaction Patient Survey Service Evaluation Form Drug reactions Line problems Patient Self- administration achieved Clinical improvement Patient readmitted within 1 month Iv doses administered on time Cost Effectiveness SIP Tracker

19.  Patient satisfaction survey:  High response rate n= 80 patients completed and returned a patient satisfaction questionnaire  101 service evaluation were returned and analysed

20. Patient Satisfaction 100% of patients felt that the training programme and treatment were well organised 100% (80/80) of patients were satisfied with the written & verbal communication throughout the Home IV training process 100% (80/80) of patients felt that education & training was of a good level and they knew that they could phone if there was a problem when at home

21. Patient Satisfaction 100% of patients thought that the referral to commencing treatment was within an acceptable time frame 100% of patients had their treatment administered on time

24.  Subsequent patient satisfaction April-June 2015 (n=20 )

25. No.QuestionYes (%) 1 Were you scheduled to start your training and treatment in a time frame that was acceptable to you? 100% (20/20) 2Do you feel that the training and treatment were well organised? 100% (20/20) 3Did you feel the training and teaching were of a good standard? 100% (20/20) 4 Did you have the team's contact details so you could contact us if you had any problems while on home IVs? 100% (20/20) 5Did we communicate clearly with you? 100% (20/20) 6Did you feel better after your home IV therapy? 83.3% (15/18) 2 N/A 7 Was having this treatment at home better and more convenient than staying in hospital? 100% (20/20) 8Was your home care delivery service satisfactory? 89.5% (17/19) 1 N/A 9 Did you receive your prescribed antibiotics from the home care delivery service on time throughout your treatment? 88.9% (16/18) 2 N/A 10Was the communication from the home care delivery service satisfactory? 94.1% (16/17) 3 N/A

26.  I recommend the home IV service/A lot better than the old way  I am happy that I can do my treatment at home  The treatment and backup have been very good  Home IV antibiotics means no hospital food!!

28. Staffing costs 2013/14£950,292 2014/15£683,701 2015/16£625,265 Bed days saved April 20162343 Pilot Cost saving :

29.  The key outcomes of the pilot identified that Home IV Antibiotic Service provides:  A safe, efficient & effective service in our patient cohort  The Home IV Service is valued by patients, high degree of patient satisfaction  The pre-mixed antibiotic option facilitated more patients being able to access Home IVs

30.  Maintain cost effectiveness: Target = 22 patients per month Pre-mixed IV antibiotics  Economic evaluation of the cost effectiveness of the service  Develop Nurse Led patient reviews  Continue to collect and analyse SIP quality indicators including patient satisfaction

31.  Dr Chris Johnson, Consultant in Respiratory Medicine  Rob Johnson, Assistant Directorate Manager  Litty Antony, Home IV Nurse  Isabel Lourenco, Home IV Nurse  Helen Gronlund, CNS Lung Defence  Princess Ward: Nursing & Medical teams  Verity Hunter, Clinical Audit Supervisor