Nursing staff who are pioneering the use of 24-hour “nurse-filled” antibiotic pumps say the approach has transformed the lives of patients and saved tens of thousands of pounds.
The innovative approach to delivering antibiotics is being pioneered in the health service by nurses at East Kent Hospitals University NHS Foundation Trust.
“It has made a phenomenal difference to the patients, who absolutely love it”
Previously patients who needed certain IV antibiotics faced hospital stays of up to six weeks but the new approach means they are able to return home almost immediately.
They are even able to go back to work with a once-a-day visit from the trust’s Hospital at Home team, according to those behind the project.
Thousands of people have benefitted from the service to date, which costs about £70 per patient per day compared with an estimated £250 per person per night cost of staying in hospital. The trust estimates that the approach has helped it save more than £1.7m during 2016-17 alone.
Gemma Oliver, nurse consultant in IV care and senior surgical matron, came up with the idea of preparing bespoke pumps for patients with a pharmacist colleague, having researched the concept and found nursing teams in Australia and the US were doing it successfully.
“It has made a phenomenal difference to the patients, who absolutely love it, because otherwise they would in hospital potentially for six weeks,” she told Nursing Times.
“We have around 25 patients out at any one time on these regimes who would otherwise be in hospital and it has had a massive impact on cost, travel and nursing intervention time,” she said.
“We just fill the pump with one day’s worth, attach it to the patient and send them home”
She also noted that users rated the service very highly, with pretty much all – 98% – scoring it five out of five in patient satisfaction surveys.
Nurses started preparing the pumps themselves in 2011 – soon after the Hospital at Home team launched.
“We used the pre-filled ones initially, but we had problems around the cold chain because they are obviously refrigerated up to the point of use,” said Ms Oliver.
“Also, you had to order them in specifically for patients and the lead time for the ordering was about three or four days,” she noted. “So, the pharmacist and I looked to see whether we could just buy the pumps and then fill them ourselves.”
The use of 24-hour elastomeric pumps – that are prepared by nurses when needed – now means patients who need certain types of antibiotic treatment can be sent home rather than staying on the wards.
“It has had a massive impact on cost, travel and nursing intervention time”
Ms Oliver said: “The drugs that we put into the pumps are flucoxacillin, tazocin and ceftazidime, so it is basically anybody who requires those antibiotics. It could be someone with a bronchiecstatis or a discitis – people who would normally have to stay in.
“Previously, they would be on four-times-day antibiotics, but we just fill the pump with one day’s worth, attach it to the patient and send them home,” she said.
The IV pump is then changed once a day by a nurse from the Hospital at Home team, which is believed to be the first nursing team in the NHS to offer the service.
Patients using the pumps can get help round the clock if there is an issue. The Hospital at Home team is available from 8am to 6pm but outside those hours patients have a direct line to a senior nurse on duty in hospital.
“She then advises over the phone or makes the decision to bring the patient back in,” said Ms Oliver. “Because the patients under the service are still classed as acute inpatients, they don’t have go through A&E, they can just come straight back in to a bed.”
“One of the keys to the service is the fact I have senior nurses in the team”
In some cases, the team is able to hand over patients to district nurses from community nursing teams provided locally by Kent Community Health NHS Foundation Trust.
“Occasionally if we have got someone who is really stable that needs six weeks’ worth of antibiotics and doesn’t have acute care needs any more, then we will hand them over to community services,” said Ms Oliver.
She said filling the pumps was relatively straightforward with some training and she had received numerous enquiries from other NHS trusts interested in doing the same.
She highlighted that a key factor in making the service possible was that the Hospital at Home team was made up of experienced, senior nurses and the fact a clear safety protocol had been drawn up.
“One of the keys to the service is the fact I have senior nurses in the team. They are all band 6 or 7 nurses because they are the only people seeing these patients who are acutely unwell and there is a high level of assessment involved,” she said.
“We have put in an awful lot of procedures around this to make sure the patients are well-supported,” she said. “It’s not just a question of filling the pump and attaching it – you need to make sure that everything that can go wrong has been considered and mitigated.”
“The first Christmas that everyone was out was a very proud moment for all of us”
She said: “For example, when it comes to the vascular access device they are using, we would always make sure they have a midline or a PICC line in – we wouldn’t attach it to a cannula and send it out.”
Flexibility was also key when it came to making a real difference to patients’ lives, added Ms Oliver.
“If someone has an ongoing chronic infection the nurses are very flexible,” she said. “So, if the patient says, ‘I am not going to be at home tomorrow but I am going to be here’, they will go and meet them where they are rather than saying they have to be in the same place.
“We had an elderly gentleman who wanted to go and see his nephew getting married. Rather than him having to leave to go back home the nurses went to the wedding reception,” she said.
“The first Christmas that everyone was out was a very proud moment for all of us, because otherwise they would all have been in hospital,” she said. “There were a lot of people who were very grateful.”