Download discharge developments across north glasgow

DISCHARGE DEVELOPMENTS ACROSS
NORTH GLASGOW
OUTPATIENT AND HOME PARENTERAL
ANTIBIOTIC THERAPY (OHPAT) SERVICE
Lindsay Semple
Project 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 Infections
Endocarditis
Bacteraemia
GU Infections
Meningitis
UTIs
Pneumonia
MDR TB
Lyme Disease
21%
Areas of Referral
A & E Depts.29%
Brownlee Unit
Orthopaedics
13%
Medical
GPs
12%
OP Clinics
Cardiology
24%
Rheumatology
12%
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
Pts. Referred
234
Pts. Included
179
Admission avoided (49%)87
Readmissions
(11%)21
Jan.’01 – Dec.’04
Pts. Referred
1089
Pts. Included
897
Admission avoided (49%)443
Readmissions
(11%)106
Bed days saved
Bed days saved
MRSA bed days
Total bed days
606
2291
MRSA bed days
Total bed days
3240
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.