Name of the organisation

Counties Manukau District Health Board (CMDHB).

Name of the service providing IV therapy in the home

Home Health Care District Nursing.

Describe the area your service covers - geography, towns, boundaries, etc.

CMDHB Region

Mangere, Mangere Bridge West, Papatoetoe, Otara, Manukau

Howick, Pakuranga, Eastern Beaches, Beachlands, Maraetai,

Papakura, Manurewa, Clevedon, Kawakawa Bay, Drury,

Pukekohe, Waiuku, Taukau, Port Waikato Sth West /Pokono Sth and Kaiawa.   

Describe the composition of your team

Clinic Bases and Home Visiting District Nursing Team.

Four Bases geographically based: Pukekohe, Papakura, Howick and Orakau Road - opposite Middlemore Hospital.

How is your service funded?

District Health Board, and ACC.

Brief description of the access criteria for IV therapy in the Home

All CMDHB in-patients requiring IV therapy are referred to the Home IV team (a team based in hospital) who assess the patients appropriateness for home IV -

• Medically stable
• Appropriate IV access (NB: peripheral access is not accepted)
• Suitable social circumstances and
• Patient/carer consent.

- Upon discharge referral made to DN\'s to manage patients in the community. (NB: follow up of these patients are managed by the Home IV team).

All referrals (including from other DHB\'s) must include

• Medical history
• Reason for IV therapy
• Plan of care, follow up appointments
• Team responsible for patients care whilst on therapy and contact numbers
• Social situation (as applicable)
• Current prescription - to include medication and flushes (highly recommended to correlate to CMDHB IV policy) and start and completion dates

 Details of PICC line with referral is also required -

• Date of insertion
• Extension tubing ?if changed
• When it was last redressed
• When the positive pressure device was last changed
• And if any difficulties experienced with flushing

All patients must have a phone available.

Who can refer

Teaching programme - for patients and staff

Delivery systems

Who administers

Frequency of visits,

Monitoring systems

Auditing processes, etc

Home IV Team / wards (CMDHB).

All other hospitals.

Private specialists (usually referred to  Home IV team also)

Transfers from other DN services (NZ and international - upon arrangement).

For the patient - usually commences whilst inpatient (Home IV team) DN\'s support this education.

For staff - IV workbook, IV Resource Nurses at each base, annual tests (currently being reviewed).  Support from Home IV Nurses.

Large population utilizing " Baxter Elastomeric Infusors".  Bolus or intermittent infusions.

Either patient self administrating or DN administrated - depends on circumstances. 

DN\'s able to visit once daily (NB: a limited PM service and no PM service in rural areas).

IV resource group, IV policy and procedure attached to annual updates/competency assessments.

Specific conditions treated

Wide range, including Chemotherapy patients.

No peripheral access accepted.

Number of patients receiving home based IV therapy

On average 20 current patients on the books at any one time.

Annual statistics (July 07 to July 08) reflect 2510 visits by DNs to administer IV therapy

Any specific problematic areas?

Lack of central resource for those referred that are not from CMDHB.

All CMDHB are managed by Home IV team (on therapy eg antibiotics).

Differences between DHB\'s of IV policies.  This poses a challenge, not only for the referrers but for the District Nurses whom are credentialed for CMDHB policy - referrers not always aware of these circumstances.

Incomplete referrals - lack of information, lack of contacts and incorrect prescriptions.

Future vision for your service

Continued expansion - increased growth of portacath usage.

Possibility of peripheral access, with all DN\'s being able to cannulate.

Are you willing to be contacted by others who may have enquiries about your IV Service in the Home?

Yes.

Contact details:

Name

Phone

Email address

Jodi Botting

09 - 270 4730 or mob 021 784 542

bottingj@middlemore.co.nz