ABSTRACT
As a national nursing service providing community nursing support for patients receiving enteral, parenteral nutrition and other intravenous therapies employing over 300 nurses, it was important to support the NHS during the Covid-19 pandemic. An NHS support campaign was launched which began by implementing a guiding principle across our service in relation to sending patients to hospital. The guiding principle was framed around keeping the patient at home safely to avoid admission. The guiding principle was: ‘why hospital, why today’. This was communicated out across our nursing service and our standard operating procedures were updated to reflect this. To help raise awareness to this initiative we also launched a logo. This was added to the email footers of the nursing team and shared with our NHS partner hospitals. We increased the nursing service offering to further support admission prevention, to include the following: • Blood taking visits • Additional drug administration • Virtual patient assessments and training • Support/facilitate virtual clinics • Condensed patient training to aid reduced number of visits for training • Rapid discharge for nursed patients We reduced the number of nursing visits our patients were having to reduce the risk through contact: • Patients were offered training for themselves or a carer • Where clinically safe and in agreements with the referring centres and our patients, we reduced patient’s visits to once a day from twice per day by administering 24-hour infusions, thus reducing contact and exposure to nurses and patients We offer a 24hour nurse Advise Line to support our patients and nurses in the community. As part of the ‘Why Hospital Why Today ‘initiative, the Advice Line worked hard to find ways to keep patients safely at home rather than advising hospital, along with discussions with the manager on call were able to reduce the number of out of hours hospital admissions. We also considered our patients mental health and well-being. Our patient cohort is a vulnerable group and they were being isolated from family and friends as well as reduced nursing visits which could impact on their mental health and well-being. We initiated weekly supportive calls to all our patients which were well received. During 2020 at the height of the pandemic, 27 hospital admissions were avoided, 6 patients completed the condensed patient training package, 160 patients had amendments to their prescription regime to reduce number of nurse visits, 63 patients initiated 24-hour parenteral nutrition infusions, halving their contact with nurses.
ABSTRACT
Community nursing support is provided for patients receiving Enteral, Parenteral and Intravenous Therapies in the United Kingdom and Ireland by a homecare company with a dedicated team of Advice Line (AL) nurses, supporting patients and nurses during the ‘out of hours’ periods. One aspect of this role is to help patients trouble shoot infusion devices via telephone call;to prevent interruption to their prescribed therapy. A Virtual Remote Assistance (VRA) process was developed using existing video calling technology to enable the nurse to visualise the infusion device and improve troubleshooting success rates and prevent hospital admission due to therapy interruption. When planning the VRA processes, we had three key aims for the initiative. Firstly, to reduce the potential of negative clinical impact due to missed or delayed treatments, as a result of the Advice Line Nurse unsuccessfully trouble shooting the infusion device over the telephone. Secondly, video calling technology has become increasingly familiar to the public as a result of the COVID 19 pandemic. We were keen to use this upturn in technology usage to provide an additional support option for patients to access. Finally, to reduce the number of infusion devices inappropriately returned for inspection, as having pumps held in the service pool reduces the number available for distribution and it has a cost implication. During Q1 of 2021, the AL team took 485 incoming calls related to patient’s infusion devices, of these, only 8.2% (N=40) calls needed to be escalated to Virtual Remote Assistance. Of those offered VRA, 30% of patients (N=12) declined participation. Of those who declined 7 did not have a device capable of completing the VRA, 3 declined with no reason and 2 could not make the connection work on their device. The AL nurses were unsuccessful in resolving the issue with 13 patients (32.5%) who were then offered care advice as per protocol. Following clinical assessment 6 patients were advised to attend hospital and 7 were able to be managed at home until a replacement device could be delivered to them, this resulted in partial missed doses for all 7 patients. The AL nurses were successful in troubleshooting the infusion devices in 15 instances (37.5%) after converting to VRA. The successful trouble shooting of the infusion devices meant that 15 patients were able to carry on their treatment at home uninterrupted and avoiding potential hospital admission for fluid management. Trouble shooting these infusion devices and enabling the patients to continue their infusion uninterrupted has improved their experience and health outcomes. As a Homecare provider, our aim is to support patients with their long-term conditions at home. The introduction of this new service area has meant that we have been able to ensure that more patients can continue to receive their therapies safely at home without disruption. Given the climate of a global pandemic it is important that the homecare provider has been able to prevent 15 hospital admissions;which not only has protected our patients but has also supported the NHS in reduce the demand for services and costs.