Enhancing at-home intravenous antibiotic therapy with remote patient monitoring

HomeLink Healthcare based in England, UK, provide expert nursing and therapeutic care within the homes of patients who have been referred from NHS or private healthcare providers.

One of HomeLink Healthcare’s NHS partners is Norfolk and Norwich University Hospital. Both organisations have come together to create NNUH at Home – a multidisciplinary team that delivers clinical care services in the home and other community settings, including nursing homes. The development of this team has allowed clinically stable patients to receive treatment and complete care in the comfort of their own home.

IVAB Therapy

One of the services provided by this team is the administration of intravenous antibiotics (known as IVABs.) IVABs are administered, as prescribed, to patients at home by a visiting nurse, with treatment lasting from a few days to several weeks or months, depending on the nature of the infection.

By providing this service, the trust can transition IVAB therapy from the hospital to the home, which affords improvements in patient flow and patient satisfaction.

Challenges of in-home IVAB Therapy

Traditionally, a patient’s clinical response to IVAB therapy is monitored by the measurement of vital signs and through blood sample analysis. Within a home environment, a nurse will measure a patient’s vital signs during the same visit as IVAB administration. Depending on the patient’s prescription, this can vary from one to four times per day.

Due to the intermittent nature of vitals recording, hospital clinicians can often delay the discharge of patients receiving IVAB therapy into the community as they are concerned potential health deterioration will not be detected soon enough in the home, resulting in hospital readmission.

Integration of Remote Patient Monitoring (RPM)

To help reduce avoidable hospital readmissions and further expedite discharge, NNUH at Home recently incorporated Current Health’s remote patient monitoring (RPM) solution into their at-home IVAB therapy pathway.

With the availability of continuous vitals data and alerts to health deterioration, the solution provides NNUH at Home with the clinical insight they need to safely monitor patients and detect the early signs of infection.
Furthermore, the broad range of parameters measured simultaneously and continuously provides greater contextual data compared to intermittent measurements which can allow more informed decisions and better diagnoses.

This was exemplified recently when one patient receiving IVAB therapy at home, exhibited a high pulse rate and repeatedly had a spiked body temperature in the evening. Ordinally, this would be a cause of concern for the patient’s care team, resulting in hospital readmission. However, following the new pathway, a virtual multidisciplinary team meeting was conducted where vital signs trends and recent blood results were analysed. Using the data, it was established due to the absence of oxygen desaturation and hypotension that this patient was not septic, allowing the patient to complete therapy at home under the supervision of the care team. Utilising data in this way was reassuring both to the hospital team and the patient.

Conclusions

The replication of inpatient monitoring within patients’ homes has provided much reassurance to not only patients but the consultant teams that remain accountable for their care.

It is anticipated that the implementation of this technology-enabled pathway will result in a greater number of IVAB referrals to NNUH at Home which will further improve patient flow, freeing inpatient beds for those requiring acute care.

In partnership with the hospital, the team aim to develop further remote care pathways for COPD and CHF to further maximise bed capacity, increase patient choice and realise cost savings.