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An evaluation of a community IV program Dixon, Beverly Lynn

Abstract

The purpose of this study was to evaluate selected outcomes for the Simon Fraser Health Region Community IV Therapy Program specifically in terms of changes in hospital stay and the frequency of safety concerns. The outcomes will provide information to the decision-makers and stakeholders about the effectiveness of the Program in providing safe care and maximizing access to hospital beds. A Program Logic Model was developed and then retrospectively applied as the Program framework. Two hypotheses examined in this pre-experimental pre-test, post-test design, tested changes in length of hospital stay for patients with osteomyelitis and cellulitis two years before the Program started (April 1, 1999 to March 31, 2000), to two years after the Program was operating (April 1, 2002 to March 31, 2003). Research questions focussed on: 1) readmission rates for patients with osteomyelitis and cellulitis; 2) readmission rates for patients in the Program during the two years of operation (April 1, 2000-March 31, 2003); 3) safety concerns for patients in the Program; and 4) whether an association could be seen between safety concerns and readmission rates. Total sampling was used to collect data from the Canadian Institute of Health Information databases, which resulted in 20 pre-test, and 13 post-test patients with osteomyelitis, and 60 pre-test and 74 posttest patients with cellulitis. The hypotheses were not supported. There was no difference in the discharge pattern for patients in the Program and for patients not in the Program, leaving a question about whether and where the patients who were not admitted into the Program received IV antibiotics. Readmissions within one month of discharge for patients with cellulitis rose from 3.4% in the pre-test year to 10.8% in the post-test year. Over one third of patients entered the Program from the community, thus avoiding a hospital admission. These patients were significantly younger than patients who stayed in hospital for their IV therapy, suggesting that there may be barriers for older patients entering the Program. The readmission rate for patients in the Program was vvdthin the community benchmark. While there were 23 documented concerns regarding patient safety, no patient required a readmission due to an incident. The Program is believed to be delivering safe care. The findings of the study were discussed and then limitations, conclusions, and implications for nursing practice, education, and administration were identified. Recommendations for further research were proposed.

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