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The Lung Defence Home IV Antibiotic and Ambulatory Care Service Karen Henderson Clinical Nurse Specialist • Bronchiectasis/recurrent respiratory infections • 2013/14 1375 • 2014/15 1566 • 2015/16 1728 The Lung Defence Home IV Antibiotic SIP: Pilot October 2013-October 2014 Patients with non-CF Bronchiectasis/recurrent respiratory infections requiring intravenous antibiotics Provide a safe, cost effective and efficient treatment option for patients to learn how to self-administer antibiotics at home Reduce hospital admission and provide treatment in an elective planned timeframe Reduce waiting times Facilitate self-care selfmanagement Patient Improve cost efficiency Reduce risk associated with admission 1 • Community based training: Self-mixed IV antibiotics 2 • Hospital Day Case admission: Premixed IV antibiotic training 3 • Hospital Day Case admission: Selfmixed IV antibiotic training Pre-mixed antibiotics Community based training Selfmixed antibiotics • • • • Day case admission Nurse home visits until D4 Outpatient review D7 and D14 Suitable for patients within 30-40 minutes drive of Papworth • Exclusion criteria • • • • Home care delivery Day case admission Outpatient review D6 and D15 Suitable for patients >40 minutes away or for those unable to self-mix IV antibiotics • Exclusion criteria Pre-Mix IVs Self-Mix IVs Home IV Pilot 2013-2014 Home IV Service 2015-2016 Home IV Training Programme Home IV Referral Clinic / LDC Telephone support service Pre-mixed or self-mix Home IV Nursing Team contact the patient by phone Discuss training process Identify Venous Access Requirements Plan day case admission Organise Prescriptions Homecare delivery for Pre-mixed IVs • Eclipse device • Pre-filled syringes • Fridge supplied for storing medication Day Case admission IV Access Specialist Physiotherapy Assessment Patient education Review of techniques First Dose Administered Final Nursing Assessment Monitor Patient /carer are confident and competent Intensive training Follow up arrangements Second dose administered by patient Day 7 & 14 Review Self-management of Home IVs Patient Engagement Robust training and Education Communication Information Accessible support Patient Support Mechanisms Local Pharmacy home care Telephone Support Line Patient Out Of Hours PRINCESS WARD Direct access to Home IV Nursing team Clinical Monitoring Process Medical Assessment Response to treatment Adverse reaction/tolerability Nursing Assessment Physiotherapy Venous Access Monitoring bloods Support & Education Airway clearance Patient education Nebulised antibiotic challenge Princess Ward Ambulatory Care Patient Satisfaction • Patient Survey Service Evaluation Form • Drug reactions • Line problems • Patient Selfadministration achieved • Clinical improvement • Patient readmitted within 1 month • Iv doses administered on time Cost Effectiveness • SIP Tracker Patient satisfaction survey: High response rate n= 80 patients completed and returned a patient satisfaction questionnaire 101 service evaluation were returned and analysed Patient Satisfaction 100% of patients felt that the training programme and treatment were well organised 100% (80/80) of patients were satisfied with the written & verbal communication throughout the Home IV training process 100% (80/80) of patients felt that education & training was of a good level and they knew that they could phone if there was a problem when at home Patient Satisfaction 100% of patients thought that the referral to commencing treatment was within an acceptable time frame 100% of patients had their treatment administered on time Symptoms Resolved with IV Antibiotic Therapy No Yes 7% 93% 100% 90% 80% 70% 60% No reply 50% No 40% Yes 30% 20% 10% 0% Accepted referral Pt statisfaction First dose Improvement Sign off On time Re-admitted Line problems Drug reactions Subsequent patient satisfaction April-June 2015 (n=20) How satisfied were you with the overall service? No. of patients 18 16 14 12 10 8 6 4 2 0 How satisfied were you with the overall service? Satisfied Very satisfied 4 16 No. Question Yes (%) Were you scheduled to start your training and treatment in a time frame 1 that was acceptable to you? 100% (20/20) 2 Do you feel that the training and treatment were well organised? 100% (20/20) 3 Did you feel the training and teaching were of a good standard? 100% (20/20) Did you have the team's contact details so you could contact us if you had 4 any problems while on home IVs? 100% (20/20) 5 Did we communicate clearly with you? 100% (20/20) 6 Did you feel better after your home IV therapy? 83.3% (15/18) Was having this treatment at home better and more convenient than 7 staying in hospital? 100% (20/20) 8 Was your home care delivery service satisfactory? 89.5% (17/19) Did you receive your prescribed antibiotics from the home care delivery 9 service on time throughout your treatment? 88.9% (16/18) 10 Was the communication from the home care delivery service satisfactory? 94.1% (16/17) 2 N/A 1 N/A 2 N/A 3 N/A I recommend the home IV service/A lot better than the old way I am happy that I can do my treatment at home The treatment and backup have been very good Home IV antibiotics means no hospital food!! Bed days saved April 2016 2343 Staffing costs Pilot Cost saving : 2013/14 £950,292 2014/15 £683,701 2015/16 £625,265 The key outcomes of the pilot identified that Home IV Antibiotic Service provides: A safe, efficient & effective service in our patient cohort The Home IV Service is valued by patients, high degree of patient satisfaction The pre-mixed antibiotic option facilitated more patients being able to access Home IVs Maintain cost effectiveness: Target = 22 patients per month Pre-mixed IV antibiotics Economic evaluation of the cost effectiveness of the service Develop Nurse Led patient reviews Continue to collect and analyse SIP quality indicators including patient satisfaction Dr Chris Johnson, Consultant in Respiratory Medicine Rob Johnson, Assistant Directorate Manager Litty Antony, Home IV Nurse Isabel Lourenco, Home IV Nurse Helen Gronlund, CNS Lung Defence Princess Ward: Nursing & Medical teams Verity Hunter, Clinical Audit Supervisor