DISCHARGE DEVELOPMENTS ACROSS NORTH GLASGOW

OUTPATIENT AND HOME PARENTERAL ANTIBIOTIC THERAPY (OHPAT) SERVICE

Lindsay SempleProject Manager/Nurse Specialist

August 2005

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

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

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

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

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

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

The OHPAT Team

• Consultant Infectious Diseases Physician

• Two Specialist Nurses

• Pharmacist

• Support from Medical team and Nursing staff within Brownlee ward as required

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

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.

Referrals can be made from:-

• All wards within NGD

• General Practitioners

• Accident and Emergency

• Outpatient Clinics

Conditions Treated

Cellulitis 64% Bone/Joint Infections21%

Endocarditis Bacteraemia

GU Infections Meningitis

UTIs Pneumonia

MDR TB Lyme Disease

Areas of Referral

A & E Depts. 29% Brownlee Unit 24%

Orthopaedics 13% Medical 12%

GPs 12% OP Clinics

Cardiology Rheumatology

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)

Quality Indicators

• Patient satisfaction

• Clinical Outcomes

• IV device infection rate

• Adverse events

• Readmission rates

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

Service activity:

Jan. ‘05 – July ’05 Jan.’01 – Dec.’04Pts. Referred 234 Pts. Referred

1089Pts. Included 179 Pts. Included 897Admission avoided (49%)87 Admission avoided (49%)443Readmissions (11%)21 Readmissions

(11%)106

Bed days saved Bed days saved

MRSA bed days 606 MRSA bed days 3240Total bed days 2291 Total bed days 13,214

Conclusion

• Quality patient focused service

• Complements other initiatives within Glasgow

• Has clear benefits for the patient and the organisation

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.