European Cystic Fibrosis Conference – Hamburg 2011

1. Email: marythe.kerbrat@perharidy.fr A teamwork on a multiregional network: an experience about harmonizing homecare practices for intravenous antibiotic on an implantable catheter port (ICP) M Kerbrat1 Nantes-Roscoff; R Fretay2 Vannes; I Berhault2, MT Jousseaume2, MC L’Abbé2, C Pingon2 and A Daniel-Bataillou2 Rennes; D Chailleux2 and F You2 Nantes; M Chiffoleau2 and S Baumard2 Angers; K Sery2 St Nazaire; M Idres2 St Brieuc; C Matras2 Tours; S Paul2, ML Madec2, F Goarant2, C Le Saint2 and Y Kerneur3 Roscoff. 1 Senior coordinator,2 Coordinating nurse, 3 Specialist nurse in hygiene In France, in 2002, together with the establishment of the CF newborn screening, 49 Specialized CF centres were labelised. In each one there are CF coordinating nurses. In France many CF patients are treated with intravenous antibiotic at home. One of the missions of the CF coordinating nurses is to organize, with the homecare nurses, the intravenous antibiotic treatment at home for patients. History:In November 2006, a group of 18 coordinating nurses of the “West of France CF network” was created, The group represents 3 regions: 4 CF adult centres, 4 paediatric centres, 2 mixed centres and 2 associated centres, for a total of 853 followed up patients. The coordinating nurses meet 3 or 4 times per year. A senior coordinator is responsible for : organizing meetings, managing projects, finding information on topics, finding resource persons, writing reports. There were 16 meetings since its inception. The objectives of the meetings:To exchange on their practices, their experiences and their difficulties, to try and harmonize protocols of care for CF patients, to review the basics: hygiene, adolescence, schooling, therapeutic education, legislation… The first meetings:To introduce themselves and get acquainted, build relationships. A first exchange, to bring out and list the topics of workand a first presentation. A first discussion about basic hygiene advice for the CF home. After the first meetings:Adesire and a willingness to work together has emerged and a list of various work tracks was draw up. “The intravenous antibiotic treatment on implantable catheter port” (ICP) has been prioritized by voting. A questionnaire survey:First, a questionnaire survey was conducted by the senior coordinating nurse, on the care practices recommended by each coordinating nurse, for the intravenous antibiotic on ICP at patient home. The questionnaire was developed and based on national guidelines. The results showed that no coordinating nurse had the same practice about ICP. And so, not the same recommendations given during the training of homecare nurses. The 3 only commonality were: Using syringes ≥10 ml as stated in national guidelines. Rinsing at the end of intravenous treatment with saline (not with the heparin). Withdrawing the needle with a positive pressure. Plan Plan Homecare for intravenous antibiotic on implantable catheter port (ICP):Is it possible to harmonize protocols for the homecare nurses on our network ? On what points ? How ? The group of the coordinating nurses decided to try and harmonize its practices through the creation of common care protocols intended for the training of homecare nurses. Do Methodology:Recommendations and references: the french national guidelines on ICP « ANAES 2000 » and a Poster of ECFS conference 2007 « improving the life of ICP » C Dupond et al. Hôpital Cochin AP-HP France. Assistance of a local specialist nurse in hygiene, a medical materials company and a regional specialist in hygiene in health’ care. Do Working together:This has meant, for each coordinating nurse: to analyse and review its own practices of care and training, to be ready to change and organize the change with the homecare nurses, to discuss during the meetings with respect and listening to one another. Two protocols have been written and tested: “Homecare recommendations for the puncture with a Huber needle on a ICP” and “Homecare recommendations for connecting and disconnecting the intravenous antibiotic on an ICP”. Some homecare nurses have read and reviewed the protocols and provided feedback Then the protocols have been validated by CCLIN (regional specialists in hygiene in health) and implemented in each centres for the training of homecare nurses … Check Today:These protocols are implemented and given during the homecare nurses training in each CF center of the « West of France CF network ». The change is gradual and easier to implement with homecare nurses newly trained. Some homecare nurses don’t follow up the new protocols. To assess the impact of this team network, the questionnaire survey on the practices about intravenous home care on ICP of each coordinating nurse, has been renewed in 2011…and the results are : The new survey shows that: No coordinating nurse has exactly the same practice… but comes near close!  The commonalities are much more numerous The nursing cares on ICP are close to the national guidelines Act So, we still have to clarify and discuss about some points and make the necessaryadjustmentsat the next meeting … “Coming together is a beginning, staying together is progress, working together is success” Henry Ford Other topics have been already discussed and worked in the group… Acknowledgments to : Each coordinating nurse of this friendly and motivatedgroup Dr Gilles Rault, coordinator of the network, who trusts us and supports the project The french CF association « Vaincre la mucoviscidose » for the financial support of these meetings, starting in 2011 for 3 years European Cystic Fibrosis Conference – Hamburg 2011