The OPAT experience in Hampshire Jorge Cepeda

1. The OPAT experience in Hampshire Jorge Cepeda

2. Dr. J. Cepeda Consultant Microbiologist Developing an OPAT service for HHFT

3. Hampshire Hospitals • Hampshire Hospitals NHS Foundation Trust serves a population of approximately 600,000 across Hampshire and parts of west Berkshire • Basingstoke and North Hampshire Hospital (BNHH) • Royal Hampshire County Hospital (RHCH) • Andover War Memorial Hospital (AWMH) provides community and hospital services

4. Hampshire Hospitals

5. The OPAT Team Helen O’Horan OPAT Nurse Specialist Taryn Keyser Antibiotic Pharmacist Dr. Jorge Cepeda Consultant Microbiologist Katie Bolam Pathology Manager

6. Understanding the model • Care Pathway • Referral • Assessment (incl. VTE) • Enrolment under OPAT • IV line (peripheral/central) • Treatment initiated ------------------------------------ • Ongoing treatment, follow up and monitoring OPAT HOPAT SOPAT Intravenous therapy under OPAT concluded

7. What we have developed Patient pathways and on-call cover were devised and the following documents were developed for the OPAT service: Operational framework Eligibility criteria (inclusion and exclusion) included on referral form (electronic) Information for patients and clinicians Patient record (electronic) Discharge summary (electronic) Patient feedback questionnaire

8. Activity Data April – September 2012

9. Patient recruitmentand ‘Marketing’ Letter sent to all heads of departments Trust wide email was sent to all clinicians and nurses to advertise the service Advert published in a Trust newsletter and on the Trust Intranet Posters disseminated to key areas:AAU, orthopaedic, surgical and medical wards Pharmacists were asked to identify suitable patients Active recruitment by all team members started on a daily basis, lead by the Specialist Nurse

10. Service delivery Predominantly outpatient day case and patient/carer administration models of antibiotic delivery All patients attend the local IV infusion unit daily to receive IV antibiotic therapy on weekdays and the Acute Assessment Unit at Basingstoke Hospital at weekends All patients reviewed daily by the OPAT Specialist nurse and once a week by Infection Specialist Regular monitoring of infection parameters, liver and renal function Weekly MDT (Virtual ward)

11. Demographics Mean age: 52

12. Who referred patients? 63% Surgical referrals

13. What patients do we cater for?

14. Antibiotics used

15. Venous access

16. Complications

17. Patients referred but not recruited N=21

18. How did we adapt the service? Transport arrangements were organized utilizing the trust transport service if appropriate Arrangements with district nurses for home administered antibiotics during weekends and some weekdays treatment were made for selected patients Extended working opening hours at the IV infusion unit for week day administration of antibiotics Training of selected patients for home self administered antibiotic therapy to facilitate weekend treatment and avoid trips to the hospital

19. Patient satisfaction 80% of all answers scored the service at the top of the score and there were no expressions of dissatisfaction In addition two patients were able to have an early return to work whilst on antibiotic therapy, in both cases they were young self employed individuals who benefitted from the flexibility provided by the OPAT service

20. Challenges of delivering an OPAT pilot Seven day service provision Out of hours cover Nursing time Communication Non attendance Funding

21. Service development

22. Conclusions 1 After 6 moths of pilot work : The OPAT service has enrolled 24 patients Had 45 patients referred and reviewed Saved 380 in-patient bed days Inserted 11 PICC lines Had 24 extremely happy costumers

23. We feel very proud of the service that we have created in such a short period of time with the limited resources provided and a number of very important milestones have been attained by developing the foundations of the OPAT service for HHFT Conclusions

24. Thank you Any questions?

25. Discharged diagnosis BNHFT 01-04-2009 to 31-03-2010

26. Reduction in hospital stay

27. Diabetic foot Pathway Referral A&E, AAU, Diabetic clinic (Admission avoidance if possible) Inclusion according to pre-agreed criteria VTE assessment PICC line insertion by Venous access Service / OPAT as a buffer service? First dose of antibiotics Transport arrangements HOPAT by district nurses / BUPA Weekly review at OPAT clinic to assess progress and diabetic clinic when required. Joint management Oral switch according to pre-agreed criteria Discharge from OPAT

28. Cellulitis Pathway Patients living within 10 miles / less than 1 hour trip A&E, AAU, Outpatients, GPs (Admission avoidance if possible) Inclusion according to pre-agreed criteria VTE assessment Peripheral cannula (72 hour change) First dose of antibiotics Transport arrangements for daily attendance Daily treatment review by OPAT nurse/doctor Early oral switch Discharged from OPAT

29. Resource development District nurses IV skills Training programme Competencies Use existing ‘Venous Access Service’ Antibiotic preparation/distribution Antibiotics reconstituted and administered by district nurse Antibiotics pre prepared at a IV infusion centre and delivered Transport Patient support 24/7 Care pathways for specific conditions Joint care with some specialities Data collection

30. Antibiotic usage OPAT UK 5 published series

31. Patient Information