the opat experience in north staffordshire neena bodasing the opat experience in north staffordshire...
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The OPAT experience in North Staffordshire
Neena Bodasing
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The OPAT Experience in North Staffordshire
Dr Neena Bodasing
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• 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 >600 000 patients a year• Offering specialised services to over 3 mill• £300 million modernisation scheme• Large geographical area with high levels of
deprivation
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Dr Neena BodasingID Consultant Lead
Barbara WhiteClinical Nurse specialistLead 1.0
Joanna WhittakerClinical Nurse Specialist0.8
Dr Tony CadwganConsultant
Dr Vasile Laza-StancaConsultant Microbiologist
The OPAT Team - who we are
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We are supported by -
Jackie YatesPharmacist
Clinical Photography Dept
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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
What is the pathway?
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Who receives OPAT?
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Who receives OPAT?
Numbers Treated
0
50
100
150
200
250
2009/10 2010/11 2011/12 2012/13 (April-August)
Age Groups
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What we Treat and What with
Condition (not exclusive)
Drugs Used
Bacteraemia Ertapenem od, Ceftriaxone od
Respiratory BronchiectasisExacerbation COPD
Ceftazidime bd, Ceftriaxone bd/od
Orthopoedic / osteomyelitis Infected JointInfected wound
Teicoplanin od/ 3x week
Neurosurgery Infected woundDiscitis
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/PPMEndocarditis
Daptomycin od, Teicoplanin od
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2663 bed dayssaved over last financial year
In-patient days saved
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Patient satisfaction
• 53% return• 99.8% of those
describing the service as excellent
• 2.55% re-admission rate• (20% non-OPAT related)
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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 - 2006/7 Service – 2008 to present time
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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
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Challenges
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Moving Goalposts
Initially emphasis on maintaining tariff for admission
Subsequently emphasis on admission avoidance
Bed days saved = beds closure?
Patient satisfaction – a priority?
Outcomes
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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
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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
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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
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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
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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
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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
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Self - administration• Carefully selected patients• Training period• Robust follow-up
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• Only two patients so farbut increasing experienceand confidence• Empowering patients and
decreasing costs
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Questions?