1. The OPAT experience in North Staffordshire
Neena Bodasing

2. The OPAT Experience in North Staffordshire
Dr Neena Bodasing

3. UHNS - one of the largest and busiest hospitals in the country with > 1,200 beds and around 6,200 whole time equivalent (WTE) employees
Caring for over > patients a year
Offering specialised services to over 3 mill
£300 million modernisation scheme
Large geographical area with high levels of deprivation

4. The OPAT Team - who we are Joanna Whittaker Clinical Nurse Specialist
0.8
Dr Vasile Laza-Stanca
Consultant Microbiologist
Dr Tony Cadwgan
Consultant
Dr Neena Bodasing
ID Consultant Lead
Barbara White
Clinical Nurse specialist
Lead 1.0

5. We are supported by -
Jackie Yates
Pharmacist
Clinical Photography Dept

6. What is the pathway? 1.8 specialist nurses based in UHNS
9-5
7 days a week
365 days per year
Patients referred from all areas of Acute Trust
GP referrals directed to A and E then OPAT referral
Nurse led clinic available for OPAT patient review – based on ID ward
Weekly ‘virtual ward round’ with all the team

7. Who receives OPAT?

8. Who receives OPAT?
Numbers Treated
Age Groups

9. What we Treat and What with
Condition
(not exclusive)
Drugs Used
Bacteraemia
Ertapenem od, Ceftriaxone od
Respiratory
Bronchiectasis
Exacerbation COPD
Ceftazidime bd, Ceftriaxone bd/od
Orthopoedic / osteomyelitis
Infected Joint
Infected wound
Teicoplanin od/ 3x week
Neurosurgery
Discitis
Ceftriaxone bd, Teicoplanin od
Cellulitis / soft tissue injury
Ceftriaxone od, Teicoplanin od
Meningitis
Ceftriaxone bd
Renal / UTI
ESBL, Pseudomonas
Ertapenem od, Ceftazidime bd
TB/ Mycobacterium infections
Amikacin od, Capreomycin
Endocarditis
Infected ICD/PPM
Daptomycin od, Teicoplanin od 9

10. In-patient days saved
2663 bed days
saved over last
financial year

11. Patient satisfaction
53% return
99.8% of those describing the service as excellent
2.55% re-admission rate
(20% non-OPAT related)

12. Setting up OPAT – the process
Feasibility study – 2003 to 2004
24 patients, 92% willing and suitable, >100 potential bed days saved
Business case – 2004 to 2005
Pilot /7
Service – 2008 to present time 12

13. Model
Hospital-based, small number of specialist nurses, under care of Infectious Diseases consultants
BUT
Existing and under-utilised intermediate care service with community-based nursing teams
No suitable clinical area in ID ward
Hospital and community “arms” of OPAT - started as pilot and expanded 13

14. Challenges

15. Moving Goalposts
Initially emphasis on maintaining tariff for admission
Subsequently emphasis on admission avoidance
Bed days saved = beds closure?
Patient satisfaction – a priority?
Outcomes 15

16. Two Primary Care Trusts
Wanted different models of care
Only one PCT funded OPAT
?post code service
Differing skills of community service in each PCT 16

17. What didn't work Repeated meetings with “key-stakeholders”
Identifying key stake-holders
Changing staff
Misconceptions re OPAT (eg all patients on IV antibiotics suitable for OPAT)
Presentations to medical staff 17

18. What did work Easy referral process
Patient hand-held notes (photocopies)
Monthly meetings between hospital and community teams
Patient letters of support
Real time data and audit (“red legs”)
Nice staff = great patient satisfaction data 18

19. What did work Weekly/monthly email to key-stakeholders
-1 line!
OPAT on agenda at Trust infection control meeting
Nurses visiting key areas (A & E, Ortho clinics, medical wards)
OPAT within hospital guidelines on cellulitis
Patient satisfaction survey presented at service user meetings and Trust Board 19

20. How does the UHNS OPAT model differ from other services?
Use of existing district nurses
allows patients to be treated in their own homes BUT training issues
Use of clinical photography to complement hand-held notes in cellulitis cases
Combination of midlines, Hickman lines, venflons and butterfly

21. Vision
OPAT team based in clinical area taking direct GP referrals in addition to hospital referrals
Integration into other ambulatory care services
Offering patient choice of
Inpatient care
Treatment at home
Daily OP care – with review by ID team
3 hospital-based nurses who rotate into community
New IRLS (Integrated Red Leg Service)
Self administration 21

22. Self - administration
Carefully selected patients
Training period
Robust follow-up

23. Only two patients so far
but increasing experience
and confidence
Empowering patients and decreasing costs

24. Questions?