16 March 2015
Young patients benefitting from home antibiotics trial
As part of an ambitious project to help Bristol Royal Hospital
for Children cope more effectively with winter pressures, staff
developed a wide-ranging 'flow' programme to ensure BRHC was as
prepared as possible for the extra demand.
Flow - key to the success of every acute hospital - refers
to the movement of patients, information and equipment between
departments and staff groups, as part of a patient's care
One key project in the programme is the paediatric outpatient
parenteral antibiotic therapy service (p-opat). This enables
children and young people who are medically stable, but require
prolonged courses of intravenous antibiotics to be managed at home,
rather than in hospital.
A community nurse visits the patient daily to administer the
antibiotics, and the patient is reviewed at weekly clinics by a
consultant. More than 50 patients, many of whom are recovering from
illnesses such as infections of the bone, chest, skin, heart, or
brain, have benefitted from the project so far.
Bernatoniene, paediatric infectious diseases consultant and project
lead, said: "It's far more convenient for families to have their
child treated in the comfort of their own home. Parents can go back
to work and children can return to school. Having more children
receiving their antibiotic treatment at home frees up beds for
other patients. We've had excellent feedback from families whose
child is participating in p-opat."
P-opat is a pilot project commissioned by Bristol Clinical
Commissioning Group (CCG). Funding was used to recruit an inpatient
clinical nurse specialist to facilitate the service, along with a
community nurse to visit patients at home. The team includes an
admin member of staff and a part-time consultant in infectious
Community staff had already been providing antibiotic therapy at
home for patients where appropriate. But the extra resources made
available through the CCG's funding meant the work could take place
on a much bigger scale.
The early results from p-opat are positive. Since the service
began, around 100 bed days per month have been saved, enabling the
hospital to admit more children and improve the flow of patients
The next phase of p-opat will see the introduction an innovative
intravenous pump system (elastomeric device), for patients who need
more than one dose of antibiotics a day. The antibiotics are
released gradually over a 24 hour period from the pump into a
peripherally inserted central line. Every day, the community nurse
will visit to replace the pump and check on the patient.
Caitlin Marnell, general manager for children's medical
specialties, said: "When you add up the total of the various
elements of the flow programme, it's clear it's been a massive
success. We have recruited more nurses, we have better
communication and we've reduced the length of stay for patients,
freeing up more beds. We haven't solved all our problems. There is
still much to do and we plan to continue building on the successes
of the programme."
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