We have been working as Clinical Nurse Specialists for Intravenous Therapy at Hounslow and Richmond Community Healthcare NHS Trust (HRCH) for the past 3 years and were instrumental in setting up the collaborative community intravenous (IV) therapy service.
As part of the national drive to provide safe, effective care closer to home and bridge the gap between hospital and community services, our collaborative IV service has reduced patients' length of stay in hospital, therefore reducing the risk of hospital-acquired infections. We also work closely with five hospital outpatient parenteral antibiotic therapy (OPAT) services and two chemotherapy day centres.
Our role is to triage IV patients for suitability for OPAT treatment, confirm capacity within the collaborative community IV therapy service (which comprises the district nursing service, night nursing service, two rapid response teams and an inpatient unit) and manage a caseload of IV patients throughout the course of IV treatment and ensure clinical governance standards are maintained.
This collaboration of all community nursing teams enables prevention of acute hospital admissions and facilitates timely discharges from acute hospital settings.
We support the multiple hospital admission avoidance schemes by working collaboratively with our pharmacy team and rapid response teams on initiating IV therapy treatment for patients on the cellulitis pathway, providing the following to clinicians and patients who access the service:
We work in collaboration with the community district nursing teams and the acute sector to allow a more flexible service in terms of care provision. We liaise between the hospitals and community teams, providing the clinical expertise and leadership for a high-risk intervention and are responsible for accepting referrals, audit, research, teaching and training staff within and across teams.
We are both non-medical prescribers and use this advanced skill on a daily basis, writing drug charts for the acute sectors, as well as independently prescribing to support the cellulitis pathway. We have bought new advanced IV skills to the team, working on new projects such as the removal of long lines in the community, which has resulted in cost savings as these patients would have been transported back to the acute sector.
We also provide all nursing staff with IV updates, which includes a numeracy test, and practical elements, such as using the Chester Chest model on which nurses practise IV therapy treatment, IV care and cannulation. This has been extremely successful and all nurses receive an IV workbook/IV passport so that their IV competencies can be signed off once achieved.
We have also supported Capital nurses (part of a programme to tackle nurse shortages in London), overseas nurses, community nurses completing district nurse training and those attending non-medical prescribing courses and we mentor students on placements within HRCH.
We support our infection control team with their aseptic non-touch technique (ANTT) project and have become ANTT assessors.
We have conducted a pilot to implement a new way of delivering IV antibiotic therapy to patients within HRCH. This has highlighted the effective collaboration of the OPAT service at West Middlesex University Hospital (WMUH) with IV specialist nurses within HRCH.
The pilot study involved one patient from Hounslow Clinical Commissioning Group (CCG) and one patient from Richmond CCG, both requiring IV therapy via an elastomeric pump. Patients were referred via OPAT at WMUH, and required a long line to be inserted by Oliver Lynch, the IV Line Practitioner at Chelsea and Westminster Hospital NHS Foundation Trust. The patients received IV medication, flucloxacillin 8 g, administered via an elastomeric pump over a 24-hour period.
Patients received daily visits at home from our collaborative IV therapy service to remove the completed pump, flush the long line with sodium chloride 0.9% 20 ml and then to attach the new elastomeric pump. This visit would last approximately 30 minutes. Patients continued to attend OPAT WMUH weekly for a medical review and a new supply of pre-filled elastomeric pumps.
In the past, patients were required to stay in hospital to receive this treatment four times daily. Alternatively, they could be referred to the community, but would have visits four times a day, each lasting an hour, as the medication required administration via a gravity infusion of sodium chloride 0.9%, 100 ml.
The pilot demonstrated that the use of elastomeric pumps to deliver appropriate IV antibiotics enabled patients to be treated in the community, saving 462 bed days. Acute and community services both benefitted from this pilot. Cost savings were made from a shorter hospital stay as well as a more efficient use of nursing visits within the community.
Our plans for the future include empowering patients to self-administer IV therapy and, working in collaboration with Oliver Lynch, inserting long lines using ultrasound scanning. We are also working with a neighbouring hospital to support setting up an OPAT service.