The Evolution of an OPAT Program in Ireland 2013-2015

Dr Susie ClarkeConsultant in Infectious Diseases St James’s Hospital

Clinical Lead National OPAT ProgramNational Healthcare Conference

Dublin May 2015

What is OPAT?

Approx 12% patients admitted tohospital receive an iv antibiotic

5% patients are only in hospitalfor their iv administration

Potential of 500 patients nationallycould be receiving their antibiotics at home

SOPAT – self-administered OPAT

SOPAT – self-administered OPAT

HOPAT

Advantages of OPAT

• Prevents social / psychological problems• Allows choices of therapy to suit individual needs• Preferred by patients• Allows for earlier discharge (reduce LOS) or prevent

hospitalisation• Eases pressure on beds• Improved efficiency of resource use

- Waiting times impact e.g orthopaedics• Reduces hospital medical / nursing staff workloads but primary

care impact must be resourced• Avoids hospital-acquired infections• Allows for effective antibiotic stewardship and auditing of

prescribing

Pre 2013 who delivered OPAT?

• Cystic Fibrosis centers for over 20 years• Small pockets OPAT primarily located in

– Centers with large Infectious Diseases sites– Some acute medical units with support of

community intervention teams

CIT Services

Current Locations of CIT Services

• Dublin North• Dublin South• Mid West

• Cork city – SouthDoc• Carlow, Kilkenny, Wicklow – CareDoc• Galway, Louth, Kildare - TCP

Community Intervention Teams• A CIT is a nurse led-health professional team which provides a rapid and integrated

response to a patient with an acute episode of illness who requires enhanced services/acute intervention for a defined short period of time.

• This may be provided in the community/home as deemed appropriate, thereby avoiding hospital admissions or facilitating early discharge.

• CIT personnel have a strong liaison role with hospital and community clinicians and provide services in the patient’s home, primary care centres and in both public and private nursing homes.

• The purpose of a CIT service is to facilitate the avoidance of an unnecessary hospital admission or attendance and to facilitate/enable early discharge of patients appropriate for CIT care.

CIT – What They Provide• IV cannulation and administration of IV antibiotics (OPAT), steroids etc.

• Acute anticoagulation care

• Acute wound care and dressings

• Enhanced nurse monitoring following fractures, falls or surgery

• Care of patients with central venous catheter

• Urinary tract related care including female catheterisation, supra pubic re-catheterisation

• Care of the patient with a respiratory illness e.g. nebuliser care, peak flow, intermittent pulse oximetry (home O2 saturation)

• Bowel care including stoma care

• Short term older person support and care

• Medication management/ administration as part of patient’s acute intervention package.

Pre 2013 who delivered OPAT?

• Cystic Fibrosis centers for over 20 years• Small pockets OPAT primarily located in

– Centers with large Infectious Diseases sites– Some acute medical units with support of community

intervention teams– BUT…..

• No national standards• A complicated and prolonged funding process• No antibiotic stewardship• Limited supply nationally• Limited capacity for expansion

January 2013

Community Intervention Teams

• Contract Awarded to TCP and Compounder

• National Standards developed and circulated

• Governance structure established

Number of referrals to the National OPAT service Jan 2013-Jan 2015 – total 4146

Jan-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13

Jul-13 Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

May-14

Jun-14

Jul-14 Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-15

HOPAT

8 20 29 44 55 42 52 52 57 60 53 55 59 49 42 46 52 51 57 54 83 57 45 43 46

SOPAT

3 4 11 22 14 26 30 17 31 32 34 36 34 27 30 40 55 28 52 50 52 63 40 52 49

CIT

NaN 15 34 21 34 33 48 51 52 48 51 59 54 35 48 37 63 62 81 34 52 53 50 62 62

CFNaN NaN 5 27 78 31 48 28 64 63 67 68 43 31 46 51 40 14 29 31 20 39 46 49 50

TOTAL

11 39 79 114 181 132 178 148 204 203 205 218 190 142 166 174 210 155 219 169 207 212 181 206 207

25

75

125

175

225

ALL HOSPITALS

SJH MATER BEAU SVUH LRH UCHG CUH AMNCH OLOL MERLIN

Ex CF Bed Days Saved

7278 6655 4589 4304 3914 2902 2883 1950 1702 1354

BDS per Re-ferral

19.356382978723

4

14.821826280623

6

9.6814345991561

2

11.663956639566

4

14.996168582375

5

13.688679245283

20.741007194244

6

12.1875 7.8433179723502

3

13.54

500

1,500

2,500

3,500

4,500

5,500

6,500

7,500

43174 Bed Days Saved Excl CF Jan 15

Bed Days Saved Jan 2013 – Jan 2015

Top Ten for Bed Days Saved

Service is been driven by SJH, MMUH, CUH and UCHG

Bed Days Saved by Referral Type

Service Referrals Est. No. of Bed Days Saved

Av. No. of Bed Days Saved Per Referral

HOPAT 2347 27612 11.8

SOPAT 830 15562 18.7

SOPAT CF 968 10340 10.7

Grand Total 4146 53514 12.9

Figures Jan 2013 – Jan 2015

AMNCH

HOPATSOPATCIT HOPAT

BEAU

HOPATSOPATCIT HOPAT

Connolly

HOPATSOPATCIT HOPAT

OLOL

HOPATSOPATCIT HOPAT

MATER

HOPATSOPATCIT HOPAT

SJH

HOPATSOPATCIT HOPAT

UCHG

HOPATSOPATCIT HOPAT

CUH

HOPATSOPATCIT HOPAT

Plans for CIT/OPAT 2015-2018

“No patient should remain in hospital that could be appropriately treated

at home”

VISION STATEMENT for the HSE CIT OPAT Programme

Plans for CIT/OPAT 2015-2018

OPAT Summary to Date

• Progression and extension of the program nationally will occur over the next 12-18 months

• The CIT OPAT program is coming to all areas • 45,000 bed days saved in the first 2 years of the program and

huge potential for more patients• The OPAT program is essentially a small virtual community

hospital with approx 250 beds occupied at any one time – not without its challenges!

• Allows for quality and safety to be established in the OPAT/CIT service

• Clear governance structures in place allowing enhanced auditing and development of the service