Bridging the gap – enhancing a multidisciplinary team Home IV service to reduce discrepancy in cystic fibrosis care

Objectives: In 2016, our large adult CF centre noted that many of our patients receiving home IVs had moderate to severe lung disease and were admission-avoidant. These patients were receiving significantly less MDT input during exacerbations than their counterparts who received regular inpatient (IP) care. We aimed to enhance our home IV service to reduce the discrepancy in care between home and IP IVs. Methods: In 2017, we established a MDT home IV service that included a consultant, 2 nurses, 2 physiotherapists and a pharmacist. Individual MDT members review patients throughout IVs, including home visits, if required. In March 2020, home spirometry was also incorporated into the service. A weekly virtual MDT ward round (VWR) occurs with patient involvement via video call, which reviews clinical outcomes, acute and long-term issues and institutes treatment changes or recommendations, where appropriate. In December 2020, a pilot survey was sent to 34 patients who had received the previous 50 courses of home IV therapy to evaluate patient experience of increased MDT input during home IVs and identify areas for further improvement. Results: Patient feedback is very positive, with 80% of respondents reporting the level of input from the new service was the right level for their needs. Comments from patients include “they no longer feel forgotten” when on home IVs. On review of the last 50 home IV courses, 34% of VWR individual patient reviews resulted in a treatment change to acute or chronic therapies and new information on adherence was gained in a quarter of cases. The majority of patients are now able to finish their IVs at home without an end of IV clinic appointment. This has beneficially reduced direct contact during the COVID-19 pandemic. An area identified for improvement by patients was the addition of dietetic and psychosocial support. Conclusion: VWR and enhanced MDT input to a home IV service promotes a bespoke, efficient and holistic approach to CF care.