1. DISCHARGE DEVELOPMENTS ACROSS NORTH GLASGOW OUTPATIENT AND HOME PARENTERAL ANTIBIOTIC THERAPY (OHPAT) SERVICE Lindsay Semple Project Manager/Nurse Specialist August 2005

2. The bigger picture A third of all admissions receive antibiotic therapy At least a sixth (21,000) patients per year receive intravenous antibiotics (IV) in North Glasgow Some patients receive prolonged IV antibiotics in hospital for e.g. Bone and joint infections, Endocarditis, Multi drug resistant tuberculosis. If they did not need IV antibiotics they could go home

3. OHPAT OHPAT is a patient focused needs led service which aims to provide seamless care between the Primary and Secondary care setting for patients who require the delivery and administration of Intravenous Antibiotics but do not require hospital admission

4. OHPAT Aims to: Provide a clinically effective, innovative, quality service Provide a service which reduces length of hospital stay or removes the need for admission at all Offers suitable patients an alternative to in-patient care

5. Benefits for patients Hospital care in the community for suitable patients that require IV antibiotic therapy Offers patients greater involvement in how their care is delivered Choice on where the care takes place giving them more freedom to continue with their daily lives

6. Benefits for Division Assists with pressure of acute admissions Assists with waiting list pressures Appropriate use of inpatient resources (nurses, pharmacists, junior doctors) Early discharge resulting in reduced opportunities for possible hospital acquired infections

7. How OHPAT started January – March 2001 Funded by winter planning April 2001-Sept. 2002 Funded by NGT and Scottish Executive as a Designed Healthcare Initiative Oct. 2002 – Sept. 2003 non recurrently funded by NGT Sept. 2003 Recurrently funded by NGD

8. The OHPAT Team Consultant Infectious Diseases Physician Two Specialist Nurses Pharmacist Support from Medical team and Nursing staff within Brownlee ward as required

9. Service availability: Based at Brownlee Centre, Gartnavel General Hospital Monday to Friday:- 8am - 4pm (including public holidays) Help line provided by Brownlee ward, Gartnavel 4pm-8am and 24 hours Saturday and Sunday

10. Patient Referrals Patients should be referred by Medical staff to the OHPAT Consultant. The exception to this are patients with skin and soft Tissue infections e.g. Cellulitis who can be referred Directly to OHPAT Nurse Specialists by Medical staff.

11. Referrals can be made from:- All wards within NGD General Practitioners Accident and Emergency Outpatient Clinics

12. Conditions Treated Cellulitis64%Bone/Joint Infections21% EndocarditisBacteraemia GU InfectionsMeningitis UTIsPneumonia MDR TBLyme Disease

13. Areas of Referral A & E Depts.29%Brownlee Unit24% Orthopaedics13%Medical12% GPs12%OP Clinics CardiologyRheumatology

14. Delivery Model OHPAT Nurses:- Assessment of patients Placement of IV devices Administration of IV antibiotics Patient education on preparation/self administration of IV antibiotics Logistics Data base and audit Weekly multidiciplinary meeting (patient focused)

15. Quality Indicators Patient satisfaction Clinical Outcomes IV device infection rate Adverse events Readmission rates

16. Developments – Patient Group Direction Developed to use for patients with skin and soft tissue Infection where named nurses can provide treatment Without a formal prescription kardex: Patient seen by a registered Medical Practitioner Referred to OHPAT Nurse Specialist Protocol followed re suitability for Rx via PGD Daily assessment and blood monitoring Drug treatment given by nurse as per protocol Nurse specialist assessment for switch to oral therapy as per protocol Follow-up by Nurse Specialist

17. Service activity: Jan. ‘05 – July ’05Jan.’01 – Dec.’04 Pts. Referred234Pts. Referred1089 Pts. Included179Pts. Included 897 Admission avoided (49%)87Admission avoided (49%)443 Readmissions (11%)21 Readmissions (11%)106Bed days saved MRSA bed days606MRSA bed days3240 Total bed days 2291Total bed days 13,214

18. Conclusion Quality patient focused service Complements other initiatives within Glasgow Has clear benefits for the patient and the organisation

19. Conclusion cont’d With the current review of bed modelling in Glasgow and the political drive to prevent people from coming in to hospital, OHPAT, along with other initiatives, has great potential. Increased investment in resources for a Pan Glasgow service could significantly increase the number of admissions avoided and early discharge of patients to help drive this forward.