Sharon Dempsey & Maureen Mackintosh ANP MERRIT NHS Lothian H@H - PowerPoint PPT Presentation

Sharon Dempsey & Maureen Mackintosh ANP MERRIT

NHS Lothian H@H teams

East Lothian H@H  Service opened Feb 2015  Team:  4 Part-time medical staff (2 consultants, 2 specialty drs)  Nursing team manager, 5 ANPs/ t-ANPs, 5 NPs, 1 Staff Nurse, 1 CSW, admin support, pharmacy  Input daily from physio & OT  Numbers per month:  40 new patients/month LOS currently around 9 days but usually several patients on 6 wk IV Abx  Sources of referral:  62% GP and 38% hospital referrals  Several patients a month on prolonged Abx (from OPAT/Ortho/Diabetes)  Close links with community hospitals for transfusions/step-up/ EOLC if needed

IOPS  Service opened in Nov 2015  Team: Consultant led, Specialty doctor & ANP/NP delivered. Access to therapy and care services via 4 Locality Hubs  Average 75 new patients per month; around 5 day LoS  75% GP referral, 25 % supported discharge  Close working with Day Hospital

MERRIT  Service opened June 2014  Currently 10 beds due to reduction in staffing – usually 15 beds.  Team: Consultant Geriatrician, Speciality Doctor , Band 7 ANP x 2, Band 6 NP x 3, Band 5 SN x 2, Admin support  Numbers per month: average admissions 30, LoS 6 days  Sources of referral: GP 75% with supported discharge 25%

H@H MERRIT Office

REACT  Service opened :May 2013  Team: Consultant physicians, Clinical fellows , and speciality doctor, ANP, Band 6 nurses, Band 5 nurses, Physiotherapists, Occupational therapists, Community pharmacist and administrator  Numbers per month: 82 patients per month over last 12 months , average LOS 4 days.  Sources of referral: 65% GP referrals , 35% supported discharges

What’s worked well  Fantastic teams, dedicated to developing H@H services  Feedback from patients and carers  Realistic medicine which supports person centred care with close working of the MDT  Holistic review of patients and their families including close working relationships with carers support groups  Individualised anticipatory care discussions with good handover to primary care  Tailoring our service to the needs of the local community  Great relationships with community therapy teams (East)  Joint training/ learning events with therapy staff and DNs

Challenging...  Medication changes...  Support from wider teams  Access to care at home – this has prompted unnecessary hospital admissions  Volume of referrals increasing which is not reflected in team expansion  Staffing – sickness absence and maternity leave like other areas, but requires contingency planning for community teams  Establishing a new service in a system not used to change  Ensuring new team members are orientated to community services in the area  Expectation that H@H can plug gaps in other services

QI & Research  H@H Oversight group – all H@H  Joint NHS Lothian Antimicrobial policy – all H@H  Joint working on Heart Failure guidelines – all H@H  Flow centre pathway for referral – IOPS, MERRIT , East Lothian  Standardised ACP discussions and documentation – REACT  Medical emergency flowchart for care homes – REACT  REACT respiratory team – home based interventions including pulmonary rehab following acute exacerbations  Pilot of new IV therapy for Bronchiectasis in conjunction with respiratory nurses – MERRIT, East Lothian  NEWS – escalation for H@H patients – MERRIT  SAS pathway – MERRIT  Warfarin management – East Lothian