The OPAT experience in

Nottingham

Tim Hills

The OPAT experience in Nottingham

Tim Hills, Sue Snape, Amanda Bort

Background and upto April 2011?• Nottingham University Hospitals

– Acute Teaching Hospital over two main sites ~1700 beds

• Current services– Cystic Fibrosis; Admission Avoidance – for 80 patients in 2010/11 –

1906 bed days

– Infectious Diseases Service IV Infusion centre model – 4 patients per day capacity. 2010: 20 patients, 341 bed days.

• Aim– Set up ID led OPAT service to orthopaedic and diabetic patients

using the patient self-administration model.

How to get the local data…Every Trust wants a feasibility study for their local hospital (Winchester)

How to get the local data…Every Trust wants a feasibility study for their local hospital

Q4. What date could OPAT start/ have started? ____________________________________________

Q5. Could the patient give their own ivs? Yes □ No □Q6. Would the patient need a HCW to administer ivs? Yes □ No □

Funding Process – Feasibility Study•Orthopaedics

•In 18 weeks 45 patients suitable for OPAT programme.•Total 829 bed days annualises to 2395 bed days/year or 6.5 beds/year.•25 likely to self administer = 382 bed days in 18 weeks •This annualises to 1103 bed days/yr or 3 beds/year

•Diabetes•In 15 weeks 25 patients suitable for OPAT programme.•17 patients discharged - 499 bed days, annualises to1729 bed days/year or 4.7 beds/year. Plus 8 patients who are still inpatients, bed days saved not determined. •9 patients (out of 17) Likely to self administer –258 bed days•This annualises to 894 bed days/yr or 2.45 beds/year

What did we do whilst waiting for nurses?

•Visited other services.•Paperwork!!•Patient held record•Patient information pack•HCW information pack, consent form, competency assessment, competency assessments, OPAT prescription

Funding Process – Pilot Oct ‘11 – March ‘12

•Reablement bid •2 nurses for 22 weeks (1 WTE Band 7 and 1 WTE Band 6), to teach self/carer-administration– Costing £75,000 per annum•Pharmacy and Consultant time unfunded•In T&O we saved 1009 bed days which annualises to 2384 bed days/year – or 6.5 beds/yr.•Total 1608 bed days saved (T&O + Diabetes 1431 bed days)– equivalent to 3800 bed days/year or 10.41 beds/year

OPAT Service PathwayPatients referred to OPAT team

• Case Accepted by consultant• Assessed and taught by OPAT nurses using competency based package

Daily attendance ID ward Discharged to self (partner/relative) administer

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All patients reviewed at the Tuesday Virtual OPAT ward round

Bloods/TDM checkedTreatment plans made

Prescriptions written by IP pharmacist New referrals discussed

Clinic Review Thursday Consultant sees new patients and problems, OPAT nurses see all patients, medication ready for collection.

Governace•Quarterly meetings

•Approve/review paperwork•Take stock of the service•Compliance to national standards•Review Outcomes

Jan-Mar Apr-June

Patients Treated 40 36

Completed full treatment in the community with cure/ improvement

90% 83.3%

Overall line complications 10% 0%

Antibiotic allergy/ reactions 20% 11%

Readmissions (reasons below) : 20.0% 11.1%

Treatment failure 2.5% 2.8%

Line problems 5.0% 0.0%

Antibiotic reactions 7.5% 2.8%

Unrelated admissions 5.0% 5.6%

Pharmacy Issues•Standardise IV administration

•TTO quantity sheet for pharmacy, helps with stock levels in dispensary.

Pharmacy Issues•Antibiotic Allergies

•Patients admitted as day attendee to receive/be taught new regimen. •Teicoplanin

•Levels at day 5 may increase further routinely checking day 7-8.•Outpatient VAT savings

•Uncompounded drugs generally too cheap for external homecare advantage.•Internal social enterprise?

•Fridge Temperatures/monitoring – Daptomycin

OPAT from a nursing perspective. Considerations before starting

• Create a clear referral pathway before the service is launched.

• Ensure basic needs for service are in place • Computers, mobile telephones/bleeps, out of hours cover and consider lone

working early for home assessments.• Support from Outpatients and launch wards/areas.• Consumables , 4 weeks supply of equipment will not be readily available from

ward areas.

• Spend time with other services ,why reinvent the wheel.

• THINK BIG IT WILL BE BIGGER THAN YOU COULD POSSIBLY IMAGINE.!!!!!Have a rough idea of service development from the offset.

Next steps…. The phased introduction of a Trust-wide OPAT service

•Pre-compounded drugs for patients unable to mix their own •Reablement bid for Health care worker administered•Admission avoidance

•Cellulitis for ambulant patients – currently working with ED/Acute Medicine and Plastics to develop a pathway – infusion centre model•Infected Bronchiectatic patients

•Other specialitiesCardiology - EndocarditisRespiratory - Infected exacerbation of BronchiectasisVascular infections

Spinal surgery – Spinal infectionsENT – Malignant Otitis Externa

Current Team• Transitional Bid funded:

– OPAT Band 7 Nurse, – OPAT Band 6 x2 Nurse, – OPAT Band 2 HCW, – Pharmacy Band 5 technician 0.2WTE – 0.15WTE Pharmacist Band 8b – Consultant 3PA +1.5PA

1st 44 weeks we have saved 3404 bed days – which annualises to 4021 beds/yr – which equates to 11.01 beds/yr

Thankyou