The challenge
Within the organisation there are several cohorts of patients that require long term intravenous antibiotic therapy (IVAB).
These include patients with bronchiectasis, cellulitis and diabetic foot ulcers.
Patients who require IVAB for bronchiectasis can wait up to two weeks for admission to hospital and are hospitalised for 14 days while they are receiving the therapy.
Most of these patients are medically stable and could receive the treatment at home in the community.
Those who are not could be discharged sooner (48 hours) after admission once the initial IVAB has been delivered and the patient becomes medically stable.
The service has since expanded to include patients with cellulitis and aims to expand further for patients with diabetic foot ulcers.
These patients require long term IVAB for up to six weeks.
Therefore receiving them in their home means an improved patient experience, reduced bed days which is costly, inconvenient for the patient and exposes them to the risk of acquiring other health care associated infections (HCAI).
Action
Sam Griffiths, clinical lead for community nursing, suggested to the service improvement team the process could be a suitable rapid process improvement workshop (RPIW).
An RPIW is a rigorous five day event that eliminates waste and improves flow through the redesign of ineffective processes.
The team members and the home team are empowered to make the changes that are needed.
These rapid changes are tested over a three month period.
The team was a collaboration of members of staff both from the trust and the community working together to improve the service for the benefits of patients.
Outcomes
As of October 2016, all community matrons in Middlesbrough, Redcar and Cleveland have now been trained to administer IV antibiotics.
Twelve (12) patients have received IV antibiotic therapy at home since early February 2016.
These 12 patients are equivalent to:
- Bed days : 158
- Money saved: £55,300
“It’s just wonderful being able to stay at home and have this treatment,” said Anne, who has four children, five grandchildren and four great-grandchildren and was first to benefit from the new service.“
Patient conclusion
The service has already saved a substantial number of hospital bed days.
The service initially required minor changes to the following feedback and re-evaluation.
Feedback from patients has been excellent and well received.
Home administration of IV antibiotics PDF