Community IV / Outpatient Parenteral Antimicrobial Pathway (OPAT) - - PowerPoint PPT Presentation

Community IV / Outpatient Parenteral Antimicrobial Pathway (OPAT)

Croydon CCG Governing Body 2nd July 2019

Background

• Benchmarking data for Croydon CCG identified ambulatory care sensitive

conditions related to infections and sepsis as areas of opportunity.

• Recommendations included the development of a model for the provision of IV

antibiotics in the community

• Feedback from clinical teams identified:
• many patients could have their treatment provided either orally, or if IV is required,

through ambulatory care / home

• Delays to Line insertions
• the need for improved approach for ongoing oversight and review
• the local OPAT pathway did not meet the best practice guidance
• Croydon Health Services is also identified as a high user of antibiotics compared

with other similar NHS Trusts:

Antibiotic usage - highest users, top 20 non-teaching Trusts in England (2017/18)

Current Pathway:

• In 2019/20:
• 9,536 patients received IV antibiotics as an inpatient at CUH
• Total of 97,540 bed days (average length of stay 10.4 days)
• NB – many of these admissions / durations of stay were for multiple conditions or needs
• Audit demonstrated that 8.21% of inpatients reviewed could have received their IV

antibiotics in another care setting

• 430 patients were treated with IV antibiotics in the ambulatory emergency care unit
• Majority of referrals were from A&E or GP
• Small number of patients care transferred from ward setting
• Audit demonstrated good impact of this existing pathway but opportunity for reducing

length of treatment

• 78 patients transferred from CUH inpatient to home based care delivered by

community nursing teams

Who can have treatment at home / in a clinic?

• Shared treatment agreement– patient, carer and clinician
• Individualised treatment – meet patient needs
• However, the following people cannot receive treatment through the community

IV pathway:

• Where the patient has no fixed abode
• Where a risk assessment identifies that the home environment is not suitable

for the administration of IV medication

• IV drug users
• Residents of nursing homes

Benefits of the new pathway for Patients:

• Feedback from patients in other OPAT services has shown that they would choose

it again rather than a prolonged hospital stay.

• allows maintenance of independence, being with their family and friends or even

returning to work.

• We expect to see the following benefits for patients:
• Improved patient satisfaction,
• Decreased Hospital acquired infection including Clostridium difficile
• Reduced length of stay or avoiding the need for admission completely
• Prevents social / psychological problems associated with admission
• Allows choice of therapy to suit individual needs
• Delivery of care in greater comfort and privacy
• More rapid return to normality (work, education)

Benefits of the new pathway – System:

• Reduced inpatient stay, easing bed pressure and allowing bed reduction or

reconfiguration:

• Improved efficiency of resource use including impact on waiting times
• Reduced hospital staff workload
• Consistent specialist infection input into patient care
• Reduction in healthcare associated infection
• Admission avoidance for some infections
• OPAT services have repeatedly been shown to be cost effective and to provide

significant cost savings in the form of bed days:

Progress to date

• Working jointly with clinical leads across the CCG and Croydon Health Services
• Audits undertaken to identify potential opportunity
• Phase 1 business case approved; including:
• Additional consultant microbiologist support (commencing 2nd July 2019)
• Additional antimicrobial pharmacist (recruitment in progress)
• Refurbishment of clinical space within interventional radiology to provide an

ultrasound intervention lab to support reduction in time to line insertion

• Pathway developed and agreed by CCG Clinical Leadership Group and One Croydon

Alliance Professional Cabinet.

• Phased approach developed to support smooth transfer of patients from one care

setting to another and to support clinical engagement.

• Engagement with patients and the public in progress to inform pathway

implementation and development of patient literature.

Implementation Timeline

Phase 1 Commenced 10th June 2019

• MDT support to Ambulatory

Care – led by the Consultant Microbiologist/ Lead Antimicrobial Pharmacist

• Patient review, optimisation
• f IV therapy and transfer to
• ral treatments.
• Protocol driven approach for

referral from A&E to reduce admissions Phase 2 Planned start date – September 2019

• Implementation of full OPAT

team including 2 nurse roles

• Oversight and review of

inpatients

• Transfer of care into

ambulatory care or home

• Reduced average waiting

times for line placement

• Additional community nurse

capacity Phase 3 Planned start date – Spring 2020

• Implementation of a self-

administration pathway

• Providing more independence

and flexibility for patients

• Implementation timeline and

pathway to be developed.

New pathway (Phase 2)

Next Steps

• Final business case approval for phase 2 (July 2019)
• Evaluation of phase 1
• Implementation and evaluation of phase 2 - through monitoring of the OPAT

National Outcomes Registry Service requirements and definitions:

• Total number of patient Episodes
• Total number of Treatment Days Saved for the quarter
• The total number of Line Events
• The total number of Drug Events
• Infection outcome by disease – cured / improved / failed
• OPAT outcome - success / partial / failed / indeterminate
• Development of phase 3 – self administration