Oxford University Hospitals (OUH) is a world-renowned centre of clinical excellence and one of the largest NHS teaching trusts in the UK, employing over 14,000 staff and has 1,059 beds. It is made up of four hospitals – the John Radcliffe Hospital, the Churchill Hospital and the Nuffield Orthopaedic Centre, all located in Oxford, and the Horton General Hospital in Banbury, north Oxfordshire. OUH provide a wide range of clinical services, specialist services (including cardiac, cancer, musculoskeletal and neurological rehabilitation) medical education, training and research.
Intravenous (IV) antibiotic therapy is regularly given for a wide variety of moderate to severe infections. This is often given as a bolus in hospitals on a 4-hourly basis. Working with the clinical and procurement teams at Oxford University Hospitals NHS Foundation Trust (FT), Vygon UK successfully piloted fresh fill elastomeric pumps as a means of enabling selected patients to receive IV antibiotics at home. This can facilitate earlier discharge and prevent hospital admissions by enabling the patient to be treated at home with a once daily home visit by the Acute Hospital at Home (AHAH) nursing team.
The use of elastomeric pumps for intravenous antibiotics is an alternative delivery method for patients. Depending on the therapy needed, these medications might include antibiotics, chemotherapy, 5FU, cytostatics, analgesics, and local anaesthetics. This case study looks at the use of fresh filled pumps to enable patients who are otherwise stable to continue their antibiotic treatment at home. The aim of this Value Based Procurement pilot was to promote the use of an elastomeric pump for IV therapy to:
- Reduce the patient length of stay, enabling them to receive IV antibiotics at home.
- Deliver savings due to bed days released.
- To promote antimicrobial stewardship.
The Vygon UK Accufuser® elastomeric pump is a safe, single use, medical infuser that enables continuous infusion of a set volume of medication within a set time period. The stable elasticity and flow through the silicon container ensures the correct amount of medicine is administered. The device can be attached to a central venous access device (CVAD) and peripheral IV lines , no additional electronic devices or tools are required.
The device is convenient, easy to carry, and does not restrict daily activities. The continued training and support for the clinical teams is key to success, Vygon UK’s partnership with OUH ensured that all barriers were discussed and overcome to meet the desired outcomes.
The current process for treating patients with IV antibiotics (primarily flucloxacillin and pip-taz) requires patients to be admitted to hospital in order to receive 3-4 time per day infusions; depending on the nature of the infection, this can mean a 7-14 day course of treatment.
In some cases, a broad-spectrum antibiotic is used to provide a once per day infusion for efficiency however, this promotes antibiotic resistance.
Vygon UK proposed a new fresh fill model whereby an Accufuser® elastomeric pump was filled with the specific antibiotic on site so that eligible patients could start their infusion and be discharged from hospital in the care of the AHAH team. This released the prospective bed days, promoted antimicrobial stewardship and increased patient satisfaction.
During December 2019 to September 2021, 86 patients were discharged with the device with a total of 1,143 bed days released, equating to cost savings of £360,410 (OUH net saving).
Feedback sought from patients during the pilot has been very positive. Most patients found the device to be comfortable and it did not restrict their daily activities. Most patients surveyed said they would use the device again.
Source: NHS Supply Chain