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

2. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro  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

3. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro … 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

4. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro 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

5. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro DVT Protocol led service Liaising with inpatient/outpatient services Microbiology/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

6. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro 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

7. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro 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

8. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro 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

9. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Welsh Assembly Government (2005) Designed for life: Creating world class health and Social Care for Wales In the 21 st 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: 84 Lives with husband Referred from: GP Diagnosis: Falls Reduced mobility Patient and husband not coping Treatment: Falls prevention Rehabilitation 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

10. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro 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 treatment Assessment 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 programme Baseline observations, Wound monitoring and pain management Provide advise regarding possible complications i.e. Chest infection, DVT, contractures, infection Removal 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 Plan Daily 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 nomogram Administer subcutaneous low,molecular weight heparin (Clexane) as per nomogram Measure 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

11. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro Mr Jones Age: 52 Referred from: Whitchurch Hospital Diagnosis: Cellulitis of both legs Treatment: Benzopenicillin 1.2 gram QDS Flucloxacillin 1 gram QDS Action Plan Qualified nurses visit 4 times daily to admin IV antibiotics Liaise with ward staff re any change in condition Monitor blood results and liaise with staff at Whitchurch Bed 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 21 st Century Mr Robertson Age: 57 Referred from: Llandough Hospital Diagnosis: Revision of Total Knee Replacement Treatment: 6 week IV Teicoplanin prophylactically Physiotherapy 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

12. Cardiff and Vale NHS Trust Ymddiriedolaeth GIG Caerdydd a’r Fro 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: 20932676 Mobile: 07976050069 08.30 - 5pm daily (Or messages may be left after hours) THANK YOU FOR LISTENING