1. Palivizumab: a centralised clinic Laura Marshall RCN Conference 13 th March 2008

2. Pavilizumab Initially marketed in the late 1990’s to prevent the incidence of RSV+ in under two’s. Due to lack of evidence and cost the JCVI made a tightened ‘at risk’ criteria for prescribing. Therefore by utilising these guideline a local protocol was implemented.

3. Local criteria Children under one year of age with chronic lung disease, receiving home oxygen therapy or prolonged oxygen use to a corrected gestational age of 36 weeks. Infants less than six months of age with a haemodynamically significant left to right shunt. Infants were selected at the discretion of the paediatric cardiologist Children under two years of age with severe congenital immuno- deficiency. Each child receives 5 doses (Oct-Feb) 15mg/kg of pavilizumab

4. Historical Background Prior to the centralised clinic babies were receiving individual home visits by a CCN per dose or attending an outpatient facility Implications:  Time  Cost  Inability to vial share In order to refine service delivery decided to pilot a centralised CCN led clinic

5. Working Party Working party set up in March 2006:  Lead CCN  Paediatric Pharmacist  Named Neonatologist  Named Paediatrician Overall aim to not only to minimise waste and cost but to increase amount of treated children

6. The clinic One clinic a month (initially for 10 children) Central location with parking Allocated appointments 90 minute clinic ran by two nurses Vial sharing Integrated care pathway Patient held records

7. Cost Analysis Year Children Treated Total Drug Expenditure (Doses given)Community Ward AttenderInpatient Average cost per dose 2004/05 621, 484 (23) 1652£934 2005/06 1036,226 (37) 13177£979 2006/07 1632,080 (57) 47010£563 75 Nursing hours saved

8. Evaluation 100% attendance throughout season Parent satisfaction questionnaire Variance tracking No children were admitted to hospital Effective social support for families

9. Season 2007/08 50 % increase in children 100 % attendance Suffolk PCT bought into the clinic for one patient.

10. Conclusion Nurse led services rapidly re shaping nursing services Local CCNT provision varies Communication between primary and secondary care paramount

11. Questions? laura.marshall@chpct.nhs.uk jackie.acornely@cambridgeshirepct.nhs.uk