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Regional Innovation Fund 2010/11 Project: PC 10013

A Pilot of Home Intravenous (IV) Antimicrobial Therapy in Lincolnshire

United Lincolnshire Hospitals NHS Trust
This project will develop ‘Step Down’ nurse-led intravenous (IV) therapy outreach service in Grantham to:
  • Improve care, dignity and independence
  • Promote patient choice of location of therapy and patient self management
  • Reduce risk of nosocomial infection
  • Improved resource utilisation           
The pilot covers a 10 mile radius of Grantham Hospital.
Lincolnshire is a rural county with a population of circa 738,000. It has poor road and rail links and public transport is limited.
Adherence to best practice guidelines (e.g. lower respiratory tract infection) has increased the use of IV antimicrobial therapy. Coupled with the continued upward trend in emergency care admissions the demand for general medical/ emergency care acute hospital beds continues to rise.
Admission to hospital can be distressing to the patient and may lead to a loss of independence and increased reliance on the health and social care sector. It can also place a burden on care givers/ significant others (who may have a protracted journeys to visit an acute unit).  Evidence suggests that hospital admission for IV therapy is:
  • Resource intensive
  • Increases risk of Hospital Acquired Infections (HAI’s) and Venous Thromboembolism (VTE).
 
Given this, alternatives to hospital care are desirable & should be developed.
Due to the technical competencies required to deliver IV therapies and the geographical population spread within Lincolnshire, existing community nursing teams have been unable to maintain recognised professional standards of competency in the delivery of IV therapies. A partnership solution would assist in resolving this issue.
This innovation would allow eligible patients to remain in their own home whilst receiving a course of intravenous antibiotics on an outpatient basis only. This delivery method is known as Outpatient Parenteral Antimicrobial Therapy (OPAT).
Although patients have to report to the hospital weekly for assessment, the treatment is delivered entirely at home, freeing up beds that would otherwise be occupied.
Whilst home IV antimicrobial therapy is innovative in the East Midlands, it is already a proven standard practice in other parts of the UK and abroad, often in urban centres. Team members have experience in operating this approach in previous engagements.
This Project will deliver four overall objectives:
  • Improve care, dignity and independence
  • Promote patient choice of location of therapy and patient self-management
  • Reduce risk of nosocomial infection
  • Improved resource utilisation
   
  • Promotion of care giver/ patient partnership in the delivery of care
  • Establishment of a high quality service closer to the patient’s home.
  • Ability to maintain independence
  • Freed up hospital facilities (improved access for elective patients)
  • Improved experience for care givers/ significant other i.e. less journey; financial cost
  • Increased personalised care (ability to design services around patient need).
  • Patient feels supported through ownership and commitment.
  • Improving patient and carer experience by providing easy access to integrated services
  • Increasing public confidence in the NHS through enhanced NHS reputation
  • Ability to shape future service delivery across primary/ secondary care boundaries
  • Opportunity to train to increased individual range of service delivery
  • Robust and consistent clinical assessment.
  • Delivery of care that improves both health and independence
  • Opportunity to build partnerships across Primary and Secondary care.
  • Improved job satisfaction/ skills for staff working in primary care
  • Positive patient feedback
  • Improved utilisation of inpatient bed stock
  • Reduced length of stay
  • Admission avoidance pathways which when implemented could extra elective capacity
  • Improved evidence-based prescribing
  • Reduction of Hospital Acquired Infection
  • Improved quality of care
  • Improved access to specialist IV technologies i.e. long Peripherally Inserted Central Catheter (PICC) lines that reduce catheter related trauma, infection and the need for device reinsertion
  • Improved concordance to pharmacotherapy
  • Cost reduction  (http://www.institute.nhs.uk)
  • Clear understanding along the whole patient care pathway
 
Estimated figures for six months for Grantham area alone (conservative estimate)
  • Bronchiectasis: six admissions, two weeks each avoided completely
  • Cellulitis: two per month avoided and two admissions shortened to between two to three days
  • Endocarditis: one to two admissions shortened from four to six weeks to under one week
  • Orthopaedics: one to two admissions shortened from four to six weeks to under one week
  • Diabetic foot infection: one to two admissions avoided or shortened from four to six weeks to under one week
  • Meningitis: one to two admissions shortened from two weeks to three days
 
Total admissions avoided for 12-14 patients with under 180 bed days – estimated tariff cost £26,000
Estimated Length Of Stay (LOS) reductions: 140 bed days at an estimated total tariff cost £28,000.
It is thought that the pilot will attract work from other PBC clusters, in addition to the above, which can be accommodated by the team.
RIF Project PC 10013 Image
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Contact the Innovator

Alun Roebuck, Bethan Stoddart, Richard Bailey, United Lincolnshire Hospitals NHS Trust

Alun.roebuck@ulh.nhs.uk

Bethan.stoddart@ulh.nhs.uk

Richard.bailey@ulh.nhs.uk

 

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Documents to Download

See the project featured in the East Midlands Regional Innovation Fund Projects Brochure on Page 49

East Midlands EXPO Poster