CAPAC and HITH seminar

Submitted by Paula Wallis, Clinical Nurse Specialist Home IV Team, CMDHB. Originally printed in December 2007 IVNNZ Inc. Newsletter

Community Acute & Post Acute Care and Hospital in the Home (CAPAC & HITH) Seminar, Stamford Plaza, Sydney, Australia, 25-26th October 2007

I was fortunate enough to attend the CAPAC and HITH seminar held in Sydney, Australia recently. This seminar, held annually, was sponsored by Baxter Healthcare.

The attending delegates had come from all over Australia with just four of us attending from 3 different DHB's in New Zealand.

The keynote speaker, Dr J. Jacobs had come all the way from Jerusalem to present the ‘Home Hospital' programme that he coordinates. Their programme focuses on geriatric services (Dr Jacobs is a Geriatrician) as they have a large elderly population in their cachement area. The Home Hospital offers services for palliative care, long term ventilated patients, rehabilitation, chronic disease management like COPD and diabetes and IV therapy. Patients are generally admitted to the service for a period of 6 months and offered access to a range of healthcare services and support which includes everything a patient may need to keep them at home and out of the inpatient setting. The Home Hospital has studied their effectiveness by decreasing the number of admissions onto their service which resulted in an increase of inpatient admissions in this geriatric population.

As well as these very interesting and informative presentations from Dr Jacobs I was also fortunate enough to hear a range of different presentations from nurses around Australia presenting on their Hospital in the Home programmes. It was exciting and reassuring to know that there is some great work going on in offering these services and it is mostly nurse driven.

I was very interested to hear that the majority of Hospital in the Home programmes in Australia run "infusion lounges" which is something we have discussed here at Middlemore Hospital, and is an initiative we would like to see in the future. Infusion lounges offer an alternative for patients having to remain in hospital and is a place where they can go to have their required IV therapy without overburdening the district nursing service with home visits for IV therapy.

Another interesting presentation for me was the St Vincent's Hospital, Sydney, Hospital for the Homeless Programme. A hospital initiative was introduced to try and reduce the number of frequent hospital admissions for 45 patients who had had between 30-80 admissions to the Emergency Department in one year.

A retrospective review of these patients found that of the 45 patients, 38 of them were homeless to some degree. Part of the hospital initiative was to set up the Community Outreach Medical Emergency Team (COMET). COMET commenced in March 2007 with a Registrar and Registered Nurse based out of the Emergency Department, but who received referrals from all areas including mental health and drug and alcohol services. The service is funded mostly by community donations and fundraising.

The treatment the service offers is therapeutic treatment (Intravenous or Intramuscular medication treatment depending on where the patient is living), wound care, home visits (if they have one), diagnostic evaluations and triaging, follow up and allied health input and linking to other services (such as drug and alcohol and mental health services). They have a vast patient mix requiring treatment for cellulitis, DVT/PE's, endocarditis, secondary syphilis, wounds, non compliance, "frequent flyers" and probably the majority of their referrals are the "we don't know what to do with this patient can you please review them".

Although they didn't have exact data on the success of their programme they are confident that in most of these 38 patients they have managed to reduce the number of hospital admissions. They rely on the support of community mental health and drug and alcohol organisations and have built up rapports with community boarding houses and "drop in" centres who will call the COMET team to notify them if one of their patients ‘turns up' and they will visit these places to see patients as required.

We recently had a patient on our Home IV programme who we discharged home to their mothers place but later found out that they were actually living in their car. At the time this seemed like a "nightmare" for us to manage and to ensure their ongoing compliance with their prescribed treatment. However, after hearing about this fantastic service that the COMET team are running out of St Vincent's hospital - well nothing seems impossible now.

There were a lot of other fantastic presentations that I could write about but I think one of the most important aspects for me attending this seminar was the networking with like minded colleagues.

I was fortunate enough to meet two nursing colleagues from New Zealand who I had not had the pleasure of meeting yet - Stella Smith from Auckland City Hospital and Phillippa Carson from Palmerston North. This gave me the opportunity to ask questions about their Hospital in the Home services and about initiatives they run that my colleagues and I are looking into at Middlemore Hospital.

I would also like to take this opportunity to thank BD for allowing me to access the prize money that I won for ‘Best presenter' at the 2005 IVNNZ Inc. conference in Hamilton. Without this funding I may not have been able to attend this seminar and I encourage all you nurses out their to take the opportunity to submit a presentation for the next IVNNZ Inc. conference to be held in Auckland in 2008 - you never know you might be as fortunate as I was and win this great prize which will enable you to attend an overseas seminar or conference - an opportunity that many nurses do not get to undertake.

According to the organisers of this seminar there is also a Hospital in the Home conference coming up in Paris, France in 2009 - that's were I am aiming for next.