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Setting up and running effective OPAT Services including competence and skills

Linda Nazarko OBE Consultant Nurse Physical Healthcare West London Mental Health NHS Trust discussed Setting up and running effective OPAT Services including competence and skills at today’s IV Therapy conference.

In her presentation Linda looked in-depth at:

  • avoiding hospital admission by providing IV Therapy treatment within the community setting
  • benefits of delivering IV antibiotics in the community
  • appropriate patient selection for community IV therapy
  • critical success factors in setting up and running an effective service
  • understanding the needs of patients receiving IV Therapy at home and the effects of long-term IV Therapy for the patient

Scroll Down for Linda Nazarko OBE Consultant Nurse Physical Healthcare West London Mental Health NHS Trust Full Presentation 

Linda Nazarko OBE Abstract:

Less than 20 years ago only a small minority of hospital inpatients were considered suitable for Outpatient Parenteral Antimicrobial Therapy (OPAT) services (Wiselka & Nicholson, 1997). Now almost 70 percent of those treated with intravenous antibiotics as hospital inpatients are considered suitable (Hitchcock et al, 2009). Around 38 - 53 percent of those requiring OPAT are able to self administer (Hills et al, 2012).

The demand for intravenous antimicrobial therapy is increasing and the way it is being delivered is changing.  The delivery of intravenous anti-microbial therapy in the community has the potential to make a huge difference to the way healthcare is delivered. It can enable people who would once have been admitted to hospital to be treated in the community.

It would be nice to see some results however what we have seen in admissions for cellulitis is an 88 percent increase in admissions over nine years. Last year though was different and inpatient admissions fell from 93,076 annually to 75,838 against a background of an ageing population (DH, 2016). Have we reached a tipping point – is out hard work starting to pay off – time will tell. OPAT can also facilitate early hospital discharge (Nazarko, 2013a). 

Potentially there are huge benefits in developing OPAT but there are also risks.  OPAT generally involves using third generation cephalosporins which can be given once or twice daily.  Our understanding is that whilst these increase C. difficile risks in hospital settings this is not the case in community settings. However as sixty percent of cases of C. difficile now develop in the community in people who have not been hospitalised we must be vigilant to such risks (Public Health England, 2013b). We may subject people to an invasive treatment when it is not necessary.  We may continue therapy when it is no longer necessary (Nazarko, 2013b: Conant et al, 2014). We may select patients for OPAT who would be best treated in hospital.  The key to providing effective safe effective care is to work together to maximise benefits and minimise risk (Duncan et al, 2013). This presentation explores the risks and benefits of OPAT, provides details on how to set up a service and examines how acute and community services can work to ensure appropriate selection of patients, appropriate treatment and appropriate follow up.

Learning points

  • The term OPAT is being adopted as a universal term to cover all IV therapy outside of in patient hospital settings.
  • OPAT can be community or hospital initiated and can be used to avoid admissions or reduce length of stay.
  • OPAT can enable people requiring parenteral therapy to remain at home or to go home sooner. This enhances quality of life.
  • OPAT once a highly specialist service is entering the mainstream
  • It is vitally important that staff from acute and community and across disciplines form a team to minimise risk and maximise benefit

Linda Nazarko OBE Biography:

Linda Nazarko, MSc, PgDip, Pg Cert, BSc (Hons), RN, NIP, OBE, FRCN is currently nurse consultant at West London Mental Health Trust.  She works across four sites and three boroughs working clinically, educating and supporting staff.

She was consultant nurse at London North West Healthcare NHS Trust until November 2015 working as a clinician, educator and adviser with colleagues in the inpatient units and within intermediate care and community teams. Linda had clinical responsibility for two nurse led inpatient wards in a community hospital.  She led a team of nurses and therapists and admits patients directly from home and from A&E into the step up unit and from acute hospitals into the step down unit.  Linda was also clinical lead for the IV service and for dementia. She has for the last year led a CQUIN on improving care for people with dementia within Ealing Community Services .

Linda lectures and assesses at universities and speaks at conferences in the UK and Europe. 

Linda’s has specialised in care of older people for 30 years and has qualifications in gerontology, physical assessment, diagnostic reasoning, prescribing, continence, stoma care, research and management.

She is the author of several books, reviews and contributes to major UK nursing journals.

Future events of interest:

Advancing IV Therapy
Wednesday 21 September 2016
Hallam Conference Centre, London

Download: Linda Nazarko OBE Full Presentation

14 April 2016


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