Download Cambridge Centre for Lung Infection Papworth Hospital

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