Families taught to use a drip so patients can leave hospital
Helen Puttick, Scottish Health Correspondent
August 28 2017, 12:01am, The Times
Patients are increasingly being treated on drips at home in a drive to keep them out of hospital and free up beds.
Families are being trained to administer antibiotics intravenously in their own living rooms so that patients do not spend days or even weeks in hospital with an infection.
NHS Lanarkshire has launched a plan to almost triple the number of patients given drugs via a drip without being admitted to hospital — a project that is expected to empty more than one and a half wards in the region.
It includes an innovative pilot scheme in which district nurses in East Kilbride have been trained and equipped to set up the intravenous lines when they visit patients. It is hoped this system could be scaled up to cover the whole of Lanarkshire and beyond, delivering the much-discussed ambition of reducing pressure on hospitals by providing more community care.
Dr Ann Chapman, a consultant in infectious diseases in Lanarkshire, said: “Most services are still based in hospitals, but I think we will see a change to services being developed in the community as long as GPs can take this on.”
Patients who have severe infections sometimes need antibiotics delivered directly into the bloodstream. Traditionally they have stayed in hospital until they are stable enough to swallow tablets. Studies have shown that up to 5 per cent of patients are in hospital beds solely because of the need for intravenous antibiotic therapy. Conditions include cellulitis infections in the skin and osteomyelitis in the bones.
However, health authorities in different parts of the UK have started to set up “Outpatient Parenteral Antimicrobial Therapy” (Opat) services where patients who are otherwise stable can go to hospital daily for their treatment or be trained to deliver it themselves at home.
NHS Lanarkshire first launched Opat four years ago. Dr Chapman, who is a key member of the Opat team in Lanarkshire, said patients usually loved it and found it empowering.
She said: “Quite often patients will make their own drip stands, they will hang a hanger from a picture on the wall. We do have collapsible drip stands but we had one patient who made one recently out of a broom handle and a stick. People are incredibly inventive.
“Most people administering their own antibiotics will have a little clean area set up in their own home. They have a special space where no family members are allowed.”
Careful training is given to ensure the drugs are given correctly and patients are checked in hospital once a week.
However, Opat in Lanarkshire can only take 14 patients at a time and often has a waiting list of people who could be discharged from wards if there was more capacity. It is now planning to expand to take 40 patients and, if the East Kilbride pilot is a success, hopes it could be rapidly extended to accept more.
Alan White, 64, has undergone three major operations following an aortic aneurysm — when the artery walls bulge. He is on permanent antibiotics to fight an internal infection. Nine weeks after his last surgery in April, Opat allowed him to return home and continue the treatment. He said that while it was fantastic to be with his family again, he felt it was too much responsibility for them to take on his IV medication, so for another nine weeks he travelled daily to Monklands Hospital in Coatbridge for the drugs.
He said: “If this pilot can come off I think it is marvellous to go out into the community with trained nurses. That is the best way, it really is. It is going to save a fortune on patient transport and stop clogging the hospitals.”
Under the system, GPs can also refer patients directly to Opat.
Marianne Hayward, head of health and social care for South Lanarkshire, said: “On any given day we might have 12 people [on antibiotics] taking up a bed in hospital who could be treated in their home. We feel the majority could be dealt with before they hit hospital.”