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The OPAT experience in North Staffordshire Neena Bodasing. The OPAT Experience in North Staffordshire. Dr Neena Bodasing. UHNS - one of the largest and busiest hospitals in the country with > 1,200 beds and around 6,200 whole time equivalent (WTE) employees

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slide3

UHNS - one of the largest and busiest hospitals in the country with > 1,200 beds and around 6,200 whole time equivalent (WTE) employees

  • Caring for over >600 000 patients a year
  • Offering specialised services to over 3 mill
  • £300 million modernisation scheme
  • Large geographical area with high levels of deprivation
slide4

The OPAT Team -

who we are

Joanna Whittaker

Clinical Nurse Specialist

0.8

Dr Vasile Laza-Stanca

Consultant Microbiologist

Dr Tony Cadwgan

Consultant

Dr Neena Bodasing

ID Consultant Lead

Barbara White

Clinical Nurse specialist

Lead 1.0

slide5

We are supported by -

Jackie Yates

Pharmacist

Clinical Photography Dept

what is the pathway
What is the pathway?
  • 1.8 specialist nurses based in UHNS
    • 9-5
    • 7 days a week
    • 365 days per year
  • Patients referred from all areas of Acute Trust
  • GP referrals directed to A and E then OPAT referral
  • Nurse led clinic available for OPAT patient review – based on ID ward
  • Weekly ‘virtual ward round’ with all the team
who receives opat1
Who receives OPAT?

Numbers Treated

Age Groups

in patient d ays s aved
In-patient days saved

2663 bed days

saved over last

financial year

slide11

Patient satisfaction

  • 53% return
  • 99.8% of those describing the service as excellent
  • 2.55% re-admission rate
  • (20% non-OPAT related)
setting up opat the process
Setting up OPAT – the process

Feasibility study – 2003 to 2004

24 patients, 92% willing and suitable, >100 potential bed days saved

Business case – 2004 to 2005

Pilot - 2006/7

Service – 2008 to present time

model
Model

Hospital-based, small number of specialist nurses, under care of Infectious Diseases consultants

BUT

Existing and under-utilised intermediate care service with community-based nursing teams

No suitable clinical area in ID ward

Hospital and community “arms” of OPAT - started as pilot and expanded

moving goalposts
Moving Goalposts

Initially emphasis on maintaining tariff for admission

Subsequently emphasis on admission avoidance

Bed days saved = beds closure?

Patient satisfaction – a priority?

Outcomes

two primary care trusts
Two Primary Care Trusts

Wanted different models of care

Only one PCT funded OPAT

?post code service

Differing skills of community service in each PCT

what didn t work
What didn't work

Repeated meetings with “key-stakeholders”

Identifying key stake-holders

Changing staff

Misconceptions re OPAT (eg all patients on IV antibiotics suitable for OPAT)

Presentations to medical staff

what did work
What did work

Easy referral process

Patient hand-held notes (photocopies)

Monthly meetings between hospital and community teams

Patient letters of support

Real time data and audit (“red legs”)

Nice staff = great patient satisfaction data

what did work1
What did work

Weekly/monthly email to key-stakeholders

-1 line!

OPAT on agenda at Trust infection control meeting

Nurses visiting key areas (A & E, Ortho clinics, medical wards)

OPAT within hospital guidelines on cellulitis

Patient satisfaction survey presented at service user meetings and Trust Board

how does the uhns opat model differ from other services
How does the UHNS OPAT model differ from other services?
  • Use of existing district nurses
    • allows patients to be treated in their own homes BUT training issues
  • Use of clinical photography to complement hand-held notes in cellulitis cases
  • Combination of midlines, Hickman lines, venflons and butterfly
vision
Vision

OPAT team based in clinical area taking direct GP referrals in addition to hospital referrals

Integration into other ambulatory care services

Offering patient choice of

Inpatient care

Treatment at home

Daily OP care – with review by ID team

3 hospital-based nurses who rotate into community

New IRLS (Integrated Red Leg Service)

Self administration

slide22

Self - administration

  • Carefully selected patients
  • Training period
  • Robust follow-up
slide23

Only two patients so far

  • but increasing experience
  • and confidence
  • Empowering patients and decreasing costs