Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Virtual Ward Care Within the Community Kay Jeynes, Head of District Nursing

Cardiff and Vale NHS TrustYmddiriedolaeth GIG Caerdydd a’r Fro

Virtual WardVirtual Ward

Care Within Care Within

the Communitythe Community

Kay Jeynes, Head of District Kay Jeynes, Head of District NursingNursing


Team established in 2001

Direct funding from the Welsh Assembly Government to reduce pressure on acute hospital inpatient beds

Intermediate care initiative Wanless review 2002 Design for Life (WAG 2005) National Framework for older people (DOH 2001)

ACUTE RESPONSE TEAM


… Health Services that do not require the resources of a general hospital but are beyond the scope of the traditional Primary Health care team (Royal College of Physicians Black et al 2000)

Care within people’s own home environment promoting speedier recovery and preventing unnecessary hospital admission. (Steiner A 2001)

“Hospital at Home”

Definition of Intermediate Care


• Physiotherapists and occupational therapists with support staff

• Qualified nurses supported by trained support staff

• Provide intensive packages of care for up to ten days, in order to facilitate early transfer of care home from hospital or prevent hospital admission.

• Based at Lansdowne site covering the GPs Cardiff and Vale geographical area

Who we are and what we do


Qualified Nurses

DVT Protocol led service

Liaising with inpatient/outpatient

servicesMicrobiology/Pharmacy

Prescribing

High level palliative care for complex

patients

Insertion of peripheral lines and IV Cannula

Maintain and provide antibiotics, monitoring blood levels, liaising with lead Physician

Nurse led monitor ongoing suitability

and safely for home treatment

NURSING


Unqualified Nurses

Support/trained to follow OT/Physio rehab careplans

Variety of skills/experience

working in community

environment

Wound care Clip/Suture

removal

Phlebotomy Baseline

Observations

Unsupervised Lone workers responsible to team manager

Trained NVQ III Provide Social

Support

NURSING


Occupational Therapy

Equipment Assessment and

Provision

Liaise with voluntary &

Statutory services

Provide safe transfer of care from home to

hospital

Facilitate a problem solving

approach towards ADL

Risk Assessments

– manual handling/falls

Functional Assessments

REHABILITATION


Physiotherapy

Rehabilitation within a 10 day

period

Treatment for trauma and orthopaedics patients following

surgery

Liaise with other teams and disciplines

Provide physio to CF patients

between the unit and home

environment

Co-ordinate safe transfer from

hospital to home

Detailed physiotherapy

assessment

REHABILITATION


Welsh Assembly Government (2005) Designed for life:Creating world class health and Social Care for Wales In the 21st Century

Mr. Andrews

Age: 62

Lives Alone

Referred From: W4

Diagnosis: Exacerbation of Bronchiectasis

Treatment:

Intravenous Antibiotics/Physio

Ceftazidime 1g TDS

Gentamycin 240mg OD

Action Plan

Nursing visits 3 times a day to administer the intravenous Antibiotics.

Take routine Bloods: U & E’s CRP LFT’s. FBC. Random Glucose. Assay for Gentamycin levels.

Physio visits once daily to administer chest physio

Occupational Therapist (OT) to call once on admission to assess equipment needs to facilitate independent activities of daily living

Community support nurses to call once daily to assist with personal care needs and rehabilitate at home.

OT to review 5 days post treatment to assess progress and discuss ongoing referral to other community rehabilitation teams or social services.

Bed days saved - 12

Mrs. Wiltshire

Age: 84Lives with husband

Referred from: GP

Diagnosis:

FallsReduced mobilityPatient and husband not coping

Treatment:

Falls preventionRehabilitation

Action Plan

Initial assessment completed by OT-Possible intrinsic and extrinsic factors to falls highlighted.

Health Promotion/Falls Prevention information provided and discussed.Equipment provided to promote safety and facilitate independence

Twice daily visits from Community Support Nurses to assist with hygiene needs in morning and evening

Physiotherapy assessment and intervention programme implemented

Liaison with Social Services and voluntary organisations for on going support on discharge from ART

Bed days saved- unknown admission prevented

Aim-to reduce the number of falls which result in serious injury and ensure effective treatment and rehabilitation for those who have fallen.National Service Framework for Older People 2001


Cardiff & Vale Orthopaedic Protocols

Mr Rees

Age: 68

Lives with wife

Referred from:

CAVOC

Diagnosis:

Elective total knee replacement

Treatment:

Intensive Physiotherapy &

Rehabilitation

Action Plan

Assess on ward for appropriateness and consent to treatmentAssessment of home environment following discharge (review of equipment requirements)Assess mobility and progress Maximising range of movement and strength through the use of a graded exercise programmeBaseline observations, Wound monitoring and pain managementProvide advise regarding possible complications i.e. Chest infection, DVT, contractures, infectionRemoval of clips (if required)Liaise with out patient physiotherapy department regarding future intervention

Bed days saved- up to 5 days if uncomplicated

Brandjes DP, Buller HR, Heijboer H et al (1997) Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombisis. Lancet 349 (9054), 759-762.

Medical Devices Agency (2201) Evaluation of the Roche CoaguchekS Coagulometer MDA 01026 ISBN number : ISBN 1 8482 344 9

Prondoni P, Lensing AWA, Prins MH, Frulla M, Marchiori A, Bernardi E, Tormene D, Mosena L, Pagnan A, (2004) Below-Knee Elastic Compression Stockings to Prevent the Post-Thrombotic Syndrome. Annals of Internal Medicine 141 (4) 249-256.

NPSA guidelines 2007 British Society of Haematology NHS UK

Ms Brown

Age: 27

Referred to Doppler via GP

Referred from: medical admissions unit

Diagnosis: Acute Popliteal DVT

Treatment: Administer heparin, monitor INR and dose Warfarin

Action PlanDaily visits from qualified nurses.At each visit ART will - Provide education and literature to support related issues i.e. alcohol, contraception.Obtain capillary INR via the near patient testing ‘Coagucheck S’Adjust Warfarin dosage as per nomogramAdminister subcutaneous low ,molecular weight heparin (Clexane) as per nomogramMeasure for compression hosiery as per best practice guidelines ( Prandoni at al 2004) and provide a prescription

Bed days saved- variable would not of been admitted but avoiding daily trips to A/E


Mr Jones

Age: 52

Referred from: Whitchurch Hospital

Diagnosis:

Cellulitis of both legs

Treatment:

Benzopenicillin 1.2 gram QDSFlucloxacillin 1 gram QDS

Action PlanQualified nurses visit 4 times daily to admin IV antibioticsLiaise with ward staff re any change in conditionMonitor blood results and liaise with staff at WhitchurchBed days saved _ length of treatment prevent admission to acute medical bed with escort

D.D saved variable dependent on patients response

Welsh Assembly Government (2005) Designed for life:Creating world class health and Social Care for Wales In the 21st Century

Mr Robertson

Age: 57

Referred from:

Llandough Hospital

Diagnosis:

Revision of Total Knee Replacement

Treatment:

6 week IV Teicoplanin prophylacticallyPhysiotherapy

Hamilton HC (2000) Selecting the correct IV device : Nursing Assessment British Journal of Nursing : 9 (15) 969-978.

RCN ( 2005) Standards for Infusion Therapy RCN IV Therapy Forum

Action Plan

Due to length of time IV antibiotics required assessed for mid line insertion as per RCN best practice guidelines

Bed days saved up to 6 weeks


ACUTE RESPONSE TEAM

Virtual ward 7.30 until midnight every day

Cardiff and Vale district nurses available for emergency calls after these hours

Referrals please telephone: 20932676Mobile: 07976050069

08.30 - 5pm daily (Or messages may be left after hours)

THANK YOU FOR LISTENING

Documents

Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Virtual Ward Care Within the Community Kay Jeynes, Head of District Nursing