Empowering Independence: LloydsPharmacy Clinical Homecare’s Home Parenteral Nutrition Initiative

At LloydsPharmacy Clinical Homecare (LPCH), our Home Parenteral Nutrition (HPN) initiative represents a significant achievement in enhancing patient independence and self-management. This initiative emerged from an audit that revealed only 55% of home parenteral nutrition patients referred for training could manage their treatments independently. In response, we assembled a multidisciplinary pilot project team comprising specialist nurses, nurse managers, and trainers to address this challenge.

Innovative Training Approach for HPN Patients

To enhance the training process, we equipped nurses with Chester chest training mannequins and recycled equipment, creating a safe and effective training environment. This set-up allowed home parenteral nutrition patients, spanning ages from 18 to 75 with conditions such as Crohn’s disease and mesenteric ischemia, to connect and disconnect from their infusions under supervision and practise repeatedly on the mannequins. This method significantly improved the learning experience, enabling patients to manage their Central Venous Access Devices (CVAD) confidently without the immediate risk of complications.

Tailored Training for Optimal Outcomes

Throughout the pilot, we scheduled regular check-ins to monitor progress and adapt the training as needed, ensuring that each HPN patient received tailored training according to their specific requirements and pace. This bespoke approach effectively addressed the complexities involved with patients who required coordination across multiple disciplinary teams and varying healthcare settings.

Positive Results

The results of this initiative have been profoundly positive:

Efficient Training: Patients achieved a level of independence within the allocated framework hours, with the average training time being approximately 14 hours—half of the maximum 28 hours set out in the framework.

Increased Confidence and Competence: Patients demonstrated increased confidence and competence in managing their HPN procedures, maintaining these improvements despite subsequent hospital admissions. Confidence scores showed significant growth from the initial meeting to 12 weeks post-independence, with detailed statistical analyses confirming the effectiveness of the training (p < 0.05).

Resource Optimisation: The project significantly reduced the nursing time required, with participants in the pilot scheme saving 91% of nursing hours that would have otherwise been required to ensure the patients received their treatment.

Unique Home Parenteral Nutrition Training

Our innovative use of mannequins and recycled equipment in patients’ homes is unique. Traditionally, such training was restricted to hospital settings, where patients had limited opportunities to practise. By enabling repetitive, risk-free practice at home, we significantly boosted patients’ self-confidence and skill levels, preparing them for independent care management without the fear of causing harm.

Multifaceted Benefits

The value of this initiative is manifold:

Increased Patient Autonomy: Approximately 85% of participants achieved full independence in tasks such as catheter care and infusion management.

Enhanced Capacity: Enables more patients to be discharged into homecare services, thus freeing up NHS bed spaces.

Comprehensive Caregiver Training: Allows for the training of multiple household members, ensuring robust support for the patient.

Collaborative Success and Expansion

This nurse-led initiative, spearheaded by a Clinical Nurse Specialist (CNS), involved close collaboration with hospital Clinical Nurse Specialists and multidisciplinary teams to tailor training plans to individual patient needs. The project’s success led to its rapid approval and expansion by senior leadership based on its initial outcomes. The interest from the NHS in expanding patient referrals validates the pilot’s success, and discussions are ongoing about broadening the scope of this training model to benefit a wider patient population. This initiative stands as a robust model of how targeted, innovative training approaches can significantly enhance patient outcomes and healthcare efficiency.