Sharon Dempsey & Maureen Mackintosh ANP MERRIT NHS Lothian H@H - - PowerPoint PPT Presentation

Sharon Dempsey & Maureen Mackintosh ANP MERRIT

NHS Lothian H@H teams

East Lothian H@H

 Service opened Feb 2015  Team:

 4 Part-time medical staff (2 consultants, 2

specialty drs)

 Nursing team manager, 5 ANPs/ t-ANPs, 5 NPs,

1 Staff Nurse, 1 CSW, admin support, pharmacy

 Input daily from physio & OT

 Numbers per month:

 40 new patients/month LOS currently around 9

days but usually several patients on 6 wk IV Abx  Sources of referral:

 62% GP and 38% hospital referrals  Several patients a month on prolonged Abx

(from OPAT/Ortho/Diabetes)

 Close links with community hospitals for

transfusions/step-up/ EOLC if needed

IOPS

 Service opened in Nov 2015  Team: Consultant led, Specialty

doctor & ANP/NP delivered. Access to therapy and care services via 4 Locality Hubs

 Average 75 new patients per month;

around 5 day LoS

 75% GP referral, 25 % supported

discharge

 Close working with Day Hospital

MERRIT

 Service opened June 2014  Currently 10 beds due to

reduction in staffing – usually 15 beds.

 Team: Consultant

Geriatrician, Speciality Doctor , Band 7 ANP x 2, Band 6 NP x 3, Band 5 SN x 2, Admin support

 Numbers per month: average

admissions 30, LoS 6 days

 Sources of referral: GP 75%

with supported discharge 25%

H@H MERRIT Office

REACT

 Service opened :May 2013  Team: Consultant physicians, Clinical fellows , and

speciality doctor, ANP, Band 6 nurses, Band 5 nurses, Physiotherapists, Occupational therapists, Community pharmacist and administrator

 Numbers per month: 82 patients per month over last

12 months , average LOS 4 days.

 Sources of referral: 65% GP referrals , 35% supported

discharges

What’s worked well

 Fantastic teams, dedicated to developing H@H services  Feedback from patients and carers  Realistic medicine which supports person centred care

with close working of the MDT

 Holistic review of patients and their families including

close working relationships with carers support groups

 Individualised anticipatory care discussions with good

handover to primary care

 Tailoring our service to the needs of the local community  Great relationships with community therapy teams (East)  Joint training/ learning events with therapy staff and DNs

Challenging...

 Medication changes...  Support from wider teams  Access to care at home – this has prompted unnecessary hospital

admissions

 Volume of referrals increasing which is not reflected in team

expansion

 Staffing – sickness absence and maternity leave like other areas,

but requires contingency planning for community teams

 Establishing a new service in a system not used to change  Ensuring new team members are orientated to community

services in the area

 Expectation that H@H can plug gaps in other services

QI & Research

 H@H Oversight group – all H@H  Joint NHS Lothian Antimicrobial policy – all H@H  Joint working on Heart Failure guidelines – all H@H  Flow centre pathway for referral – IOPS, MERRIT , East Lothian  Standardised ACP discussions and documentation – REACT  Medical emergency flowchart for care homes – REACT  REACT respiratory team – home based interventions including

pulmonary rehab following acute exacerbations

 Pilot of new IV therapy for Bronchiectasis in conjunction with

respiratory nurses – MERRIT, East Lothian

 NEWS – escalation for H@H patients – MERRIT  SAS pathway – MERRIT  Warfarin management – East Lothian