Intravenous diuretics in the community
This disabling and distressing condition can have a major effect on the quality of life for patients and their families. Around 550,000 people have heart failure across the UK.
As the condition worsens, fluid accumulates in the lower limbs and eventually in the abdomen. Oral diuretics help reduce fluid retention, but as the disease progresses, they are often not enough to control symptoms. With the current system, the patient will then usually need admission to hospital for intravenous (IV) diuretics treatment, typically involving a stay of several days or longer.
Heart failure patients who wish to die at home are often unable to stay at home due to the need for IV diuretics.
The call for change
It was just so much more comfortable. It’s all the little things, like being able to go to bed when you like.
Heart failure patient
UK health policy has been shifting towards care being provided as close to home as possible. This is driven by the twin priorities of improving quality of care and cost-effectiveness.
Norah Taggart (84, pictured) has had heart failure for more than three years. On two occasions her body has retained a significantly high amount of excess fluid. The first time, she spent three weeks in hospital and was connected to an IV drip to treat the problem. But in June 2012 when she stopped responding to her usual tablets, she received a second IV treatment regime - this time in the comfort of her own home.
What we did
We funded a two year project with 10 NHS organisations across the UK in both urban and rural areas to assess whether funding a home or community based IV diuretics service is safe, clinically effective, cost effective and well received by patients and carers.
The funding supported Heart Failure Specialist Nurses to develop and introduce community-based IV diuretics services as part of existing heart failure services. An independent external evaluation was undertaken.
You can order or download our CPD accredited Delivering IV Diuretics in the Community summary booklet, which breaks down the findings of our external evaluations This includes the proposal, cost savings, and an outline of the service design and approach by healthcare professionals on our pilot caring for people with Heart Failure in the community.
You can read the evaluation report for the IV diuretics pilot by BrightPurpose and learn more about the impact of the programme.
Evidence for change
The findings and feedback showed the intervention was safe, clinically and cost effective. Crucially, the services was well received by patients and their carers.
Mrs Taggart said: “I used to feel guilty about my husband visiting me each day in hospital too. He’s 84, he’s had his hips done, so it’s not easy to get around, and trying to park at the hospital is a nightmare. I feel much better knowing he doesn't have to cope with all that too.”
- The pilot was very successful, with 100% of patients and 93% of carers preferring home-based treatment over hospital admission
- 1,040 bed days were saved across the sites during the two year pilot
- An average cost saving of £3,013 per community based intervention (£793 community based IV diuretics vs £3,796 hospital based IV diuretics)
Our innovative pilot has been adopted by NICE guidance as a QIPP case study demonstrating best practice. The work has also been applauded in the Nursing Times citing benefits of adopting this service model.
With the right infrastructure and resources, existing Heart Failure Specialist Nurse teams can provide a service that enables patients to have IV diuretics delivered effectively and safely in the comfort of their own home.