1. The pitfalls and joys of establishing a community OPAT service Helen Forrest The pitfalls and joys of establishing a community OPAT service Helen Forrest

2. The Pitfalls and Joys of establishing a Community IV Therapy Service Helen Forrest - SEQOL

3. Assignment Business case for Community IV Therapy Service – Aim – Predominantly to prevent hospital admission, also to facilitate earlier discharge by providing an effective Community based Intravenous Therapy (CIVT) service

4. Assignment Connect with SEQOL vision Innovative Model of delivery Equal to inpatient care if not superior Demonstrate benefits to stakeholders patients, commissioners and why winning formula Where CIVT will operate How will we get there Time frame based on three conditions – Cellulitis – Pneumonia – COPD ASAP No service specification Supporting people to make the most of their life Passionate about People Working together, as one Valuing individuals and communities Inspiring ourselves and others

5. Within existing resources

6. SEQOL IV Therapy Project Lead WHY ME? ICN Not giving IV Therapy No ‘Hands on’ 13 years RCA’s MRSA bacteraemias highlighted concern around IV therapy management Implemented ANTT - Aseptic None Touch Technique IPS IV Therapy Forum Lower Limb Cellulitis Pathway – AA pilot Passion for patient safety issues New ways of working Backdrop of new organisation and period of rapid change

7. Stakeholders Identify important customers internal and external Opinion leaders on side Early meeting to get opinions, understanding of complexities of challenge and buy in

8. Project team Lead inc IP&C Clinical lead Director Operations Director Finance Professional Nurse Lead HR IT Governance Risk manager Community Nurse Lead Practice educators Discharge Liaison GP OOH Microbiologist Pharmacist Partnership working with Acute Trust Within SEQOL Not within SEQOL Determine model of service

9. Plan Criteria from other organisations – service specifications How other teams deliver services Contacted nurse specialists Networking – IPS IV forum – study days – OPAT – BC Toolkit – NIVAS – – Pathways workshops research guidance

10. Lack of experience Shift of activity from acute to community Funding and resources Identifying numbers of patients Difficult to predict number of avoided admission Coordinating hospital and community care Clinical accountability Ensuring patient safety and outcomes Risk management

11. Vision Current activity Via SPA & Acute Trust Comprehensive IV Therapy service Home Work Day unit Nurse led specialist team Self administration Integrated community and acute team Integrated VAD insertion services Year 1Year 5

12. Community IV Therapy Service Build it and they will come

13. Current position majority of IV therapy is currently provided by the DGH some patients referred to the community nursing teams, mostly patients requiring long term IV antibiotic therapy via a central line other IV medications are administered on a patient by patient basis ad hoc (SPA) 753 visits to 103 patients

14. Local experience Swindon has strong association with manufacturing and railways COPD largest cause of non elective admissions Quality Outcome Figures 2006-2007 of 1.5% of the population put the PCT above the national and SHA ratings Some patients with long term conditions are currently managed at home using Telehealth. These patients are being admitted unnecessarily for intravenous therapies. Audit has demonstrated that during these admissions there was a reduction in the patient’s independence, increase in infection, loss of time and quality of life which could have been spent at home. Some patients refuse admission

15. Based on Halton and St Helen’s Model of delivery

16. Expected outcomes Better faster patient centered timely equitable care Improved patient experience. Improved clinical outcomes including reduced risk of acquiring HCAIs Reduction in admissions for IV therapy. Promote early discharge. Reduction in length of stay. Reduction of admissions (LTC & telehealth patients) Reduce burden on community nursing services. 90% of patients referred into the service are offered treatment at home or CIVT day unit

17. Joys They said YES Opportunity to really improve patient experience Great learning experience Job satisfaction - motivation Team work Partnership working SEQOL = income generated goes back into services Patience

18. Next steps Get the money in the bank Recruit specialist nurses Detailed implementation plans Pathway, policy, protocol development Marketing the service Pilot – evaluate Refine Fully implement Evaluate Future Determination to secure future funding Develop the service Community IV Therapy Service