In long-term care, it can be a struggle when you have to send your residents to hospital. Studies have shown that hospitals can have a negative effect on frail seniors and may not be the place that they need to be.
To this end, GERAS Centre (Geriatric Education and Research in Aging Sciences) conducted a study to see if hospital visits could be avoided if some treatments occurred in long-term care homes.
"The aim of the study was to target intravenous therapy for with antibiotic treatment or hydration that would prevent residents from having to go to hospital," says Loretta Hillier, Project Coordinator for the Long-Term Care Homes' IntraVenous Therapy Experience (LIVE) study.
"The study was driven as a quality improvement initiative. We know that frail seniors don't do well in the emergency department or in hospital," she notes. "Oftentimes, there are adverse events associated with hospitalization."
Hillier points out that the transition from home to hospital can be stressful for the resident and their family members.
"We know that residents prefer to receive as much medical care as possible within their long-term care home," she states. "There's real value to having the people providing the medical care know the patient."
Hillier notes that "typically, not in all long-term care homes, but probably the majority, when a resident is suspected of having an infection that may require IV antibiotics, they're transferred to hospital."
The aim of the study was to reduce those transfers.
"We had four homes participate in the study," says Hillier. "It ran for nine months and we had 12 residents access the service."
While the numbers do seem low, Hillier points out that there were low rates of infection in the Niagara region during the study which was one of the reasons why there weren't as many participants.
And of course, there are criteria as to whether residents can be treated on site.
"These are medical criteria like whether they are able to eat or drink," Hillier comments. "There are criteria around pulse rates, respiratory rates, oxygen saturation and blood pressure. If they meet those criteria, they can stay in the long-term care home."
Lack of Resources
So why don't more long-term care homes provide IV therapy?
"It's a matter of resources," Hillier says. "They may not have the nursing capacity to administer or monitor IV's. They may not have access to equipment that's needed and they may not have access to the consultation support — that decision-making process that is needed to determine what the best treatment is for infection."
In recognizing that these were important barriers, part of the implementation of the study, Hillier says, was providing those resources.
"Each home was provided with nursing support and had access to the nurse practitioner outreach team that could help them with the decision-making process."
Medical Pharmacies Group Ltd was a partner and helped connect them with the supplies needed as well as provided consultation with a pharmacist.
"One of the things we learned in this study is that this kind of service can't happen in isolation," Hillier states. "It really needs support in terms of education, nursing, and pharmacy support. It can't happen in a vacuum."
The study produced some interesting results.
The clinical pathway that was developed during the study became an important tool, Hillier says, for nursing staff and physicians to discuss the assessment and management of infection.
"Residents were identified earlier," says Hillier, "so the first line of treatment— oral antibiotics— were effective so they didn't need to move on to something stronger like an IV antibiotic."
Another interesting facet of the study was that everyone became interested in not only preventing people from going to the hospital but getting people who were in the hospital on IV therapy out of the hospital sooner.
"We were able to shorten the length of hospital stay for three residents whose IV therapy was initiated in hospital," Hillier states. "Because the long-term care home had the capacity to manage IV therapy, those three residents were discharged sooner."
Hillier also points out that "The other key finding from the study was that there were no adverse events. Providing IV therapy in long-term care homes did not result in inferior care."
This is an important result because it proves that IV therapy can be done in long-term care with with right training and equipment.
Education and Partnerships
So how can long-term care homes implement IV therapy?
Hillier notes that "it starts with education and it starts with partnering with the resources in their community to help support this initiative. So that would be partnering with their pharmaceutical company, their medical supply company and other initiatives."
So it's not about starting from scratch on your own. Instead, Hillier says, it's about "looking at what partners, what expertise exists that can support long-term care homes to do this."
Ultimately, the study proves that long-term care facilities can embrace IV therapy to aid in their residents' quality of life.
"Long-term care does have the skills and the capacity to offer this kind of service," Hillier says firmly. "They just need the resources to help support it."