SERVICE EVALUATION OF A CYSTIC FIBROSIS HOME INTRAVENOUS ANTIBIOTIC SERVICE PROVIDED BY A NHS FOUNDATION TRUST
Authors: Elsey Lynn 
Published: August 2016

Aim

To evaluate carers' satisfaction with the current service for home reconstitution and administration of intravenous (IV) antibiotics to cystic fibrosis (CF) patients and identify ways of improving this service to reduce treatment burden.

Methods

A formative evaluation was conducted of all 17 carers who reconstituted and administered the IV antibiotics at home. This was carried out using a cross-sectional survey. A questionnaire of open and closed questions was sent first class with a pre-paid return envelope to the carers. This was followed by a reminder letter after the set return date.

Results

Thirteen carers responded giving a response rate of 76.5%. The carers had a mean of 2 children in the household with all having 1 child under the care of the paediatric CF team. They had been receiving IV antibiotics for a mean of 8 years and 7 months and had been administering them at home for a mean of 6 years and 1 month. The majority had administered the antibiotics in the last 3 months.

Over half received their drugs from the hospital pharmacy, but one carer highlighted that they did not always receive a full supply of the treatment.

Removing the reconstitution step by providing pre-prepared syringes could reduce treatment time by around 18 minutes. Overall this could mean a daily reduction in treatment time of almost two hours for a patient who is on two antibiotics three times a day. The majority of respondents stated that they would prefer pre-filled syringes.

The carers felt that they received enough training and felt confident in reconstituting and administering the antibiotics. The majority felt that they should receive regular updates to their training and it was highlighted that they are reassessed at the start of each course. Most of the carers felt that they had an opportunity to discuss the IV antibiotics in the out-patient clinic with the doctors and the nurses but none of them would contact the pharmacist. They felt that they were appropriately contacted in advance to organise when the course would start and a proportion were contacting the nurses in advance to organise the treatment around their commitments. When they receive the antibiotics and sundries from the hospital pharmacy they are supplied with written directions for reconstitution and administration. However, the carers did not find these easy to understand. It was highlighted by one that they could not access advice at night.

Overall the carers had a high level of satisfaction with the service. Some felt that it could be improved by easier access to advice, having blood tests done by community nurses and pre-filled syringes.

Conclusion

Overall this cohort is satisfied with their current home IV service. Improvements could be made by: ensuring carers always receive 100% of all necessary supplies; better access to advice; easier to understand written information; access to blood tests in community; increased awareness of the pharmacist. The majority of carers would like pre-prepared syringes and these could greatly decrease the treatment time.