the pitfalls and joys of establishing a community opat service helen forrest the pitfalls and joys...
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The pitfalls and joys of establishing
a community OPAT service
Helen Forrest
The Pitfalls and Joys of establishing a
Community IV Therapy Service
Helen Forrest - SEQOL
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
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 PeopleWorking together, as one
Valuing individuals and communitiesInspiring ourselves and others
Within existing resources
SEQOL IV Therapy Project LeadWHY 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
Stakeholders
• Identify important customers internal and external
• Opinion leaders on side• Early meeting to get opinions,
understanding of complexities of challenge and buy in
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
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
• 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
Vision
Current activity
Via SPA & Acute
Trust
Comprehensive
IV Therapy service
Home Work
Day unit
Nurse led specialist
team
Self administrati
on
Integrated
community and acute team
Integrated VAD insertio
n services
Year 1 Year 5
Community IV Therapy Service
Build it and they will come
Current position
IV therapy contacts
April -Sept 2011
0
20
40
60
80
100
120
140
160
180
April May June July August September
Month
No
. of
visi
ts
• 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
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
Based on Halton and St Helen’s
Model of delivery
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
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
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