IV therapy in the community.

Community i.v. therapy services can be of significant benefit to both patients and the NHS. They can prevent hospital admissions and facilitate early discharge, improve patient safety by reducing the risk of infection and improve choice by enabling patients to stay in their homes. However, the availability, standard and uniformity of these services varies throughout the UK. This article describes the benefits of delivering i.v. therapy in the community and provides guidance for nurses on setting up a service.

Effective practice in community iv therapy.

The government has policies for care in the community, reducing acute admissions and length of hospital stays and greater patient choice (Department of Health (DH) 2002; DH, 2006) but the NHS has no overall strategy for community intravenous (IV) therapy. Despite this, community IV therapy is expanding to cover a wider range of medication and therapies. While this enables community nurses to extend their skills it can also present many challenges. Carrying out this form of treatment in the community requires comprehensive organization and multidisciplinary working. This article aims to cover the key aspects that need to be in place to ensure that community IV therapy is safe, appropriate and manageable and that infection control is maintained.

Audit of peripheral venous cannulae by members of an i.v. therapy forum.

This article describes a clinical audit of peripheral venous cannulae (PVC) undertaken by members of a national intravenous therapy forum. PVC care was reviewed using the RCN 'Standards for Infusion Therapy' and the Department of Healh's 'Winning Ways' report, action area 2 (DH, 2003; RCN, 2003) to define best practice. Data were collected by members of the forum and submitted for analysis by the members' coordinator. The findings of the audit highlighted several areas for improvement in PVC care. The most significant finding was poor documentation of the insertion of the cannula. An additional concern was that the person who performed the cannulation could not be identified for 236 (37.7%) of PVC audited. Draft recommendations with strategies for implementation have been proposed and feedback sought from participants with plans to re-audit in 2007.

Strategies to reduce the risk of needle and sharps injuries.

Needle or sharps injuries are common, underreported and often preventable (Department of Health, 2004). This article describes when, how and why these injuries occur and who is at risk. It provides an overview of recent legislation and outlines strategies to minimise risks.

Vascular access: indications and implications for patient care.

This overview of the vascular access devices available for adult patients explains how careful selection and management of the device can minimise the complications associated with infusion therapy.

Needlestick and sharps injuries: avoiding the risk in clinical practice.

What is the true incidence of needlestick and sharps injuries among health-care professionals in the UK and what is the real cost of such injuries? This article identifies the obvious and not-so-obvious risks to staff in community and hospital settings and examines how such risks can be minimised, drawing on guidance from NICE and the RCN.

Outpatient parenteral antimicrobial therapy (OPAT): is it safe for selected patients to self-administer at home? A retrospective analysis of a large cohort over 13 years.

OBJECTIVES: Provision of outpatient parenteral antimicrobial therapy (OPAT) is an evolving field, facilitating discharge from hospital for selected patients with serious infections. We report on a large OPAT cohort focusing on the practice of supervised parenteral antibiotic administration in the community by patients and relatives, which we collectively term 'self-administration'. To distinguish between healthcare professional OPAT and self-administered OPAT, we have coined the terms H-OPAT and S-OPAT, respectively. PATIENTS AND METHODS: We analysed data on 2059 OPAT episodes collected prospectively over a 13 year time period from 1993 to 2005. RESULTS: Clinical diagnosis, microbiology and antibiotics in this OPAT series are comparable to those previously reported. We identified no excess complications or hospital re-admissions in the S-OPAT group compared with the H-OPAT group. CONCLUSIONS: Self-administration of intravenous antimicrobial therapy, in selected patients under the supervision of a specialist team, is a safe and feasible strategy.