The OPAT experience in North Staffordshire Neena Bodasing

1. The OPAT experience in North Staffordshire NeenaBodasing

2. The OPAT Experience in North Staffordshire Dr Neena Bodasing

3. 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

4. The OPAT Team - who we are Joanna Whittaker Clinical Nurse Specialist 0.8 Dr Vasile Laza-Stanca Consultant Microbiologist Dr Tony Cadwgan Consultant Dr Neena Bodasing ID Consultant Lead Barbara White Clinical Nurse specialist Lead 1.0

5. We are supported by - Jackie Yates Pharmacist Clinical Photography Dept

6. What is the pathway? • 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

7. Who receives OPAT?

8. Who receives OPAT? Numbers Treated Age Groups

9. What we Treat and What with

10. In-patient days saved 2663 bed days saved over last financial year

11. Patient satisfaction • 53% return • 99.8% of those describing the service as excellent • 2.55% re-admission rate • (20% non-OPAT related)

12. 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

13. 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

14. Challenges

15. Moving Goalposts Initially emphasis on maintaining tariff for admission Subsequently emphasis on admission avoidance Bed days saved = beds closure? Patient satisfaction – a priority? Outcomes

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Self - administration • Carefully selected patients • Training period • Robust follow-up

23. Only two patients so far • but increasing experience • and confidence • Empowering patients and decreasing costs

24. Questions?