Chris Goodwin, Senior QC Analyst, Betsi Cadwaldr University Health Board
I’m Chris, and I am the Senior Analyst within the Pharmacy QC team at Wrexham and I am also part of the Bevan Exemplar programme’s Cohort 8.
15 months ago, I had some discussions with the Lead Antimicrobial Pharmacist here in Wrexham where he told me about the OPAT service that he was piloting and looking to scale up. OPAT stands for Outpatient Parenteral Antimicrobial Therapy and really simply what that means is having intravenous antibiotics outside of the hospital using the devices pictured to the left*. This has many benefits to the patient as they can be with family, go to work as well as many other quality of life improvements. There are also benefits to the Health Board in regards to patient flow, freeing nurse time and cost reductions.
I had not heard of this way of treating patients before but it sounded like a great option for patients to have, and the patient feedback on the service really reinforced these thoughts:
“I would absolutely use the service again; I think it is a fantastic idea with many benefits”
Unfortunately, the service was not being used to its full potential. The reasons being that not only are the devices needed quite hard to get hold of in a ready to use fashion but also very difficult to make yourself, particularly in the volume the service may require. The challenges it was facing did not seem insurmountable and so from these discussions, a rather ambitious project was set out:
Can we use semi-automation within the manufacturing suite in Technical Services to offer these devices in an efficient, cost effective manner and more importantly can we do it in the 12-month time span of the Bevan Exemplar programme?
Turns out you can, although it is a lot of hard work! Drawing on the expertise we have available in both the laboratory and manufacturing teams; new analytical methods were developed logistical barriers were overcome and production methods were refined. Over the course of the programme, we have managed to achieve the following:
- Reduction in manufacturing time by 85%
- Shelf life increase of around 300%, and also generated some data to enable room temperature storage
- Cost reduction of around 90% when compared to an in-patient and 80% compared to purchasing pre-filled OPAT device.
These outcomes highlighted to us the role that technology has in developing the aseptic service here in Wrexham and how by embracing these advances and change we are able to manufacture a product that we reasonably could not 10 years ago. Not only that, but it demonstrated how much ability there is within our technical services team and that we should have the confidence to push our service further and into new directions to better meet the ever evolving requirements of modern healthcare and, more importantly, patients.
2024 is looking to be an exciting year as we use the transferable learning points to begin development on new drug dosages and molecules so that we can offer a wider catalogue of treatments that will enable treatment of a wider range of illness. We are also investigating other ways that technology can create efficiencies within the department freeing up capacity of the production team and increase the output of products.
*I would like to say that it is perfectly safe and controlled. Patients are vetted for suitability, trained and monitored by a team of nurses; patients are not left to their own devices with needle and vials of drugs, a concern I have come across quite a lot over the course of this project!
