Nurse's new skills allow for earlier discharges home from hospital

A specialist nurse is helping to get patients home from hospital sooner after completing a 10-month course alongside her full-time job.

Cassie-Jo Layzell is a senior vascular access nurse within vascular access and outpatient parenteral antimicrobial therapy (OPAT) services in Morriston Hospital.

The OPAT team manages the delivery of intravenous (IV) antimicrobials to patients so they can return home to continue receiving their treatment there instead.

Once back home, patients continue to receive their care from community-based staff.

Cassie (pictured) is responsible for the insertion, care and maintenance of vascular access devices, which allow for repeated or long-term access to the bloodstream for administration of IV therapy.

“Around 80 per cent of patients in hospital will need some sort of vascular access device,” Cassie said.

“OPAT supports patients who receive any IV antimicrobial therapy, which could be antibiotics, antiviral or antifungal medication.

“It means people can continue to receive their treatment outside of hospital, whether that is in their own home, a primary care clinic or elsewhere.”

As the number of patients requiring OPAT began to increase, the team identified a need to prescribe IV medication more quickly.

Cassie decided to put herself forward on a non-medical prescribing course which would allow her to prescribe patients’ medication herself, leading to a quicker discharge from hospital.

For 10 months she juggled studying on the course with her full-time job, alongside her busy family life with two young sons.

She added: “It was intense. There were so many different aspects.

“You learn about the mechanism of action of the drugs you are planning to prescribe, as well as how the body responds to and manages them.

“We learned about the guidelines and legislation surrounding prescribing and practised prescribing so we would feel confident once qualified.

“We also learned how to carry out specific clinical examinations and to take detailed histories of patients, allowing for safer independent prescribing.

“There were a lot of lectures over the 10 months and at the end we had to undertake an exam and discussion based on case studies from our portfolios that were submitted earlier in the year. They were based on real life patients from our clinical practice.

“I was juggling it all with full-time work. I’m very lucky as I’ve got a really supportive team who really helped me.”

After completing the course with a distinction, Cassie has been able to prescribe medication for patients being discharged on OPAT.

Previously, a doctor had to prescribe the medication which, because they are so busy, often led to a delay in the patient being discharged.

As well as allowing quicker discharges, Cassie’s new skills also help to ease pressures on the Emergency Department as beds will become available sooner.

“Before, I would have had to have waited for a ward doctor to become available or maybe my lead nurse,” Cassie said.

“Trying to get hold of a ward doctor could be quite difficult as they are so busy.

“Whereas now I can carry out the insertion of the vascular access device, complete the OPAT pathway, write their prescription chart and then the patient can be on their way home.

“It has massively sped up the discharge process.”

As well as improving the discharge process, Cassie’s skills also help ensure patients are prescribed the most appropriate treatment for their diagnosis.

Wherever possible and appropriate she makes sure to change their antibiotics to an oral alternative or stopped if no longer needed, helping to reduce the risk of antimicrobial resistance (where bacteria are exposed to antibiotics and become resistant so they no longer work).

Since completing the course, Cassie has been recognised at the health board’s annual Living Our Values Awards and took home the Learner of the Year award.

“It was overwhelming when I found out,” she said.

“It was lovely to receive the recognition and it made all of the hard work worthwhile.”

Frankie Thompson, lead nurse for vascular access and OPAT services, said: “By prescribing for patients being discharged on OPAT, Cassie is helping to facilitate faster discharges within the acute hospital setting which in turn supports patient flow and improved patient experiences.

“Cassie has also been able to act more effectively as an antibiotic guardian, working with colleagues to ensure patients are discharged with the most appropriate treatment.

“I am very proud of Cassie for receiving this award as well as completing her course and value and respect the contribution she makes to our team.”