Swansea Bay service wins award for helping to treat more patients safely at home

A Swansea Bay service which treats patients safely at home and keeps them out of hospital has been recognised with an award for its excellent care.

The Outpatient Parenteral Antimicrobial Therapy (OPAT) multi-disciplinary team treats people who have an infection that requires an intravenous (through a vein) antimicrobial but are well enough to stay at home or be seen in an outpatient setting.

Antimicrobials include medicines like antibiotics, antifungals and antivirals which target a wide range of infections. By delivering treatments away from hospital, patients can often carry on with their normal lives outside of appointment times.

The OPAT service works collaboratively with healthcare professionals, such as microbiologists and infectious disease specialists, to identify patients who are suitable to be discharged from hospital to safely receive their treatment at home. Some patients can avoid hospital admission altogether with an early intervention.

The team also manages the risk of re-admission, while improving patient outcomes.

The OPAT service’s approach to working collaboratively to ensure the best outcomes for patients led to the team winning the Delivering Our Partnership Compact Award at the health board’s most recent One Bay Way Awards.

But the team isn’t resting on its laurels and is introducing innovative new methods to make life easier for patients, while cutting costs and workloads at the same time.

“It’s a case of everybody working together and trying to work smarter, not harder,” said Frankie Thompson, who is the lead nurse for both the OPAT and vascular access services. Vascular access refers to accessing the venous system to administer medication or fluids by inserting the right device in a timely fashion.

Pictured above: Frankie Thompson receiving the award on behalf of the OPAT service.

“The award we received was for our extensive partnership working. With OPAT, the patient is at the centre of everything we do. My team, the vascular access team, microbiology staff, the infectious diseases team, antimicrobial pharmacists, the referring team and the acute clinical team nurses who deliver the care in the patient’s home all work closely together for the patient.  

“When we see an inpatient referral who requires a line for the administration of intravenous antimicrobial therapy, one of the things we always consider is whether the patient could receive this therapy at home.

 “We can then assess their suitability for OPAT by linking in with the infectious diseases or microbiology teams and asking if there is a suitable treatment regimen to treat the patient at home in an equivalent way to them staying in hospital.”

OPAT services have existed since the 1970s but today, they continue to expand to cover new areas. One such emerging area is palliative OPAT. This is where an infection cannot be cured but can be supressed with lifelong antimicrobial therapy. This provides the patient with symptomatic relief, improving quality of life and reducing distress from symptoms, particularly at end of life. It also means patients can remain at home with their family.

Frankie added: “We expect to be able to deliver the same standard of care out in the community as we can provide in a hospital.

“I’ve been in post in Swansea Bay for nine years and it has taken time to get to where we are now. Nine years ago we didn’t have any infectious diseases consultants. We had some input from microbiology but at the time, they weren’t really aware of regimes that were suitable for OPAT.

“Whilst not all regimens are suitable, where OPAT can deliver them at home, most patients tend to prefer it. Being at home offers so many benefits.

“It’s more convenient for both the patients and their family, removing the need for time-limited hospital visits.

“Patients are more likely to relax in their home environments, surrounded by everything that is familiar to them. They sleep better in their own bed and tend to eat better at home, both of which are known to promote better healing outcomes.

“They are also more likely to avoid the risks of deconditioning if they are out of a hospital bed and at home, getting up and about. Some of them even return to work - albeit almost certainly from home. Quality of life improves in so many ways.”

The OPAT multi-disciplinary team meets weekly to discuss any issues with antibiotics, vascular access devices and patient treatment plans.

“We have good links with services across the whole of the South Wales corridor because we’re a tertiary centre for some specialities. We have patients from near and far, from Aberystwyth to Newport,” added Frankie.

“From a health board perspective, you have patients where the number of days in hospital is reduced or even better, avoided. You can assess patients at home and provide the care they need without them ever having to walk through the hospital door.

“I always say if we can’t get people out of hospital, we can’t get other people in.”

Frankie also outlined some of the innovative ways in which time and resources are being saved while also making life easier for patients.

She said: “We’ve introduced a new way of administering one of our antibiotic drugs, which in the past has been administered once a day for seven days.

“Now, if the patient is suitable, we only make three visits a week. This frees up nursing time, the patient’s time and it’s less travel time and cost. The drug is called Teicoplanin and we introduced the new regimen for suitable patients a few months ago.

“We’re also currently working on a project with an antimicrobial pharmacist to deliver continuous, 24 hour antibiotic infusions via an elastomeric device.

“This will mean one home visit a day for patients who would otherwise need four visits, which we currently can’t do because of the hours the team works. Added to which, if you need someone to come out to your home every six hours, that’s going to severely disrupt a patient’s sleep.

“It will allow us the ability to use two antibiotics we haven’t been able to use before, which means we should now be able to discharge even more patients with different types of infections.

“The patient will be attached to the infusion, contained in a small bag. The equipment doesn’t require any batteries or programming.  The nurse attaches the infusion, it empties itself over the day and then it’s topped up the next.

“We are planning to train nurses to be able to prepare the infusion in the patient’s home and administer it. This will again reduce costs as we’re not buying the medication ready-made and also won’t have to worry about storage and refrigeration.”