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Nursing Times Awards 2010

Team of the Year Award

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WINNER: Nurse led outpatient antibiotic therapy, Elizabeth Swanson and colleagues, South Tees Foundation Trust. Award sponsored by Unison

Background

The outpatient antibiotic therapy (OPAT) clinic was formally established in 2007 to treat patients from South Cleveland with chronic infected wounds and other infections as outpatients, sparing them prolonged hospital admission. Patients who attend receive intravenous antibiotics and specialist wound management and care.

The initiative’s aims were twofold:

  • To reduce patient length of stay;
  • To improve the quality of patient experience.

The benefits are significant for the patient and the organisation in reducing length of stay, and reducing the incidence of healthcare associated infections (HCAIs). Our patient feedback is consistently “excellent”, with no complaints in over three years.

The process

The nurse-led OPAT service commenced hospital-wide in 2007. The original estimates of activity used within its business case proved to underestimate the usefulness of the service and in its first year the clinic doubled its estimated targets, saving 3,800 bed days. Since 2007 we have saved over 14,112 acute hospital bed days.

The OPAT clinic runs seven sessions per week, seeing on average 20 patients each session. As referrals are taken from all specialties, all types of wounds and infections are seen and treated. This requires advanced wound care knowledge. Essential to this are the strong working relationships between the consultant for infection control, the matron for wound care, the OPAT nursing team and other stakeholders. The OPAT nursing team consists of one band 7 sister, one band 6 sister, three RNs and two healthcare assistants. The OPAT service has expanded to include a nurse-led infliximab clinic and a MRSA decolonisation clinic pre-surgical intervention and post discharge follow-up.

Advice to other organisations

An effective OPAT service has been made possible after our business case was accepted by the trust board. The theme of the business case was that we should invest to save, and it clearly demonstrated the potential financial benefits to the organisation and the likely benefits to patients of introducing a nurse-led OPAT clinic.

Since it was established the clinic has flourished and this can be attributed to its strong nursing leadership, its dedicated team of experienced nurses and the team’s willingness to work collaboratively with specialist clinicians, specialist nurses and local GPs. Building these relationships has been a key factor contributing to success.

We have tried throughout to be flexible, taking patients from all specialties with a wide range of infection and wound problems. The success of the initiative is also due to our commitment to the patient from initial referral, through antibiotic therapy to complete care of their wounds and resolution.

The nursing staff are experts and to date have not made a single intravenous drug administration error. They have used initiative and implemented a stopwatch system to ensure antibiotic therapy is administered within the correct time in accordance with British National Formulary advice.

Benefits of the initiative

The provision of the nurse-led OPAT service has over the past three years allowed thousands of patients to receive specialist care as an outpatient rather than in hospital. This has had both physical and psychological benefits for patients, and enabled them to continue living normal lives meeting their family and work commitments. The feedback we receive demonstrates that patients want and need the service we offer.

The initiative has also had numerous benefits for the trust; it is estimated to have saved our organisation over £500,000 per year in inpatient treatment costs and has also freed up valuable inpatient beds for other patients.

Our infection control rate record for the last year was excellent. The overall rate of HCAIs was one per 3,479 procedures. This compares very favourably with published rates of infections. For example, US guidance suggests that bacteraemia rates related to central lines should be below three per 1,000 days of treatment. Our clinic itself has had no bacteraemias.

Financial implications

The development of an OPAT service required some investment, particularly to provide seven day staffing. However, within the same financial year, immediate savings can be achieved. These come from reduced length of stays, improved productivity and reduced HCAIs.

By concentrating expertise in one area, every patient receives optimal wound management and appropriate antibiotic therapy from their first visit. The OPAT model of service delivery offers an option for more complex outpatient specialist care to be developed. A service such as OPAT will help acute hospitals to meet the government’s proposed 30-day discharge responsibility target.

Contact

For more information on this initiative please contact Elizabeth Swanson: Elizabeth.swanson@stees.nhs.uk

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