DISCHARGE DEVELOPMENTS ACROSS NORTH GLASGOW

1
DISCHARGE DEVELOPMENTS ACROSS NORTH GLASGOW

• OUTPATIENT AND HOME PARENTERAL ANTIBIOTIC THERAPY
  (OHPAT) SERVICE
• Lindsay Semple
• Project Manager/Nurse Specialist
• August 2005

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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

3
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

4
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

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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

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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

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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

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The OHPAT Team

• Consultant Infectious Diseases Physician
• Two Specialist Nurses
• Pharmacist
• Support from Medical team and Nursing staff
  within Brownlee ward as required

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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

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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.

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Referrals can be made from-

• All wards within NGD
• General Practitioners
• Accident and Emergency
• Outpatient Clinics

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Conditions Treated

• Cellulitis 64 Bone/Joint Infections 21
• Endocarditis Bacteraemia
• GU Infections Meningitis
• UTIs Pneumonia
• MDR TB Lyme Disease

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Areas of Referral

• A E Depts. 29 Brownlee Unit 24
• Orthopaedics 13 Medical 12
• GPs 12 OP Clinics
• Cardiology Rheumatology

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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)

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Quality Indicators

• Patient satisfaction
• Clinical Outcomes
• IV device infection rate
• Adverse events
• Readmission rates

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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

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Service activity

• Jan. 05 July 05 Jan.01 Dec.04
• Pts. Referred 234 Pts. Referred 1089
• Pts. Included 179 Pts. Included 897
• Admission avoided (49)87 Admission avoided
  (49)443
• Readmissions (11)21
  Readmissions (11)106
• Bed days saved Bed days saved
• MRSA bed days 606 MRSA bed days 3240
• Total bed days 2291 Total bed days
  13,214

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Conclusion

• Quality patient focused service
• Complements other initiatives within Glasgow
• Has clear benefits for the patient and the
  organisation

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Conclusion contd

• 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.