How Advanced is your ANP knowledge? by Barbara Tamburrini

Advanced nursing practice is not a new concept. Indeed, specialist nursing roles, from which advanced nursing practice has evolved, have been around since as early as the 1920’s. The advent of World War 2 dramatically enhanced the specialist nurse role through the significant development of new skills which were required to meet the huge and urgent demand in hospitals and infirmaries throughout the world. The clinical nurse specialist (CNS) role was underpinned by academic qualifications as early as 1954 and over the following decades, these nurses were fully embraced as experts in their fields. This academic foundation represented a momentous shift in the educational vision for nurses towards university-based knowledge development with expertise achieving the application of this knowledge in practice.

With CNS roles being conceptualised as fundamental to in-patient care quality, the nurse practitioner role was developed to replicate this degree of specialism in primary and community care. During the 1990’s, universities within the UK began to affiliate nurse practitioner courses with graduates predominantly practising in GP practises to address the targets around 24 hour access to healthcare professionals and 48 hour access to a GP. These nurse practitioners were trained to assess minor injuries & illnesses which freed GPs up to review and manage patients with more complex needs.

During the 1970’s, very specialised nursing roles emerged in areas such as pain management and colorectal surgery and less than 20 years later, academic institutions were making BSc Nurse Practitioner qualifications widely available with paediatric, primary care or hospital based routes all an option for graduation. This was further enhanced by the advent of the Hospital at Night (H@N) concept, piloted early in the 21st century and rolled out across the UK by 2006.

Here in NHSD&G, we have had nurse practitioners achieving significant levels of specialist nursing in GP surgeries for 2 decades and in the Acute and diagnostics Directorate, the H@N concept was introduced in 2006 with an initial team of 6 advanced nurse practitioners (ANPs). These nurses hit the ground running with assessing unwell & deteriorating adult in-patients overnight and gradual recruitment has enabled development into a weekend daytime role. The manifestations of this role evolution is evidenced by increased continuity and quality of in-patient care, decreased residual clinical tasks and reduced numbers of un-planned critical care admissions by promoting the early recognition and management of deteriorating patients. Furthermore, a presence has been fully established within the medical admission unit and an ambulatory care pathway has been formulated which is delivering on its commitment to reduce medical emergency admissions.

Within the Emergency Department, ANPs have been managing a case load of stream 1 (minors) presentations since 2005 when 2 existing members of staff commenced their ANP course & carved out this new role. This team gradually increased to 3 ANPs once the benefit on improved ED flow was realised. In recent years, the ANP presence in ED, has developed to include presentations in stream 2 (majors) and stream 3 (resuscitation) and this has contributed significantly to achievements in ED HEAT targets whilst also maximising ED patient care.

The Galloway Community Hospital also now has an ANP presence with a crucial role to play in the acute “Garrick” ward in addition to supporting the patients within the “Dalrymple” rehabilitation ward. In addition, advanced practitioners are now clinically active in the neonatal, obstetrics, gynaecology and paediatric specialities within NHSD&G and a number of GP practices around the region benefit from ANPs working alongside their GP, practice nurse, CNS, district nurse & health visiting colleagues. Indeed, a new and exciting venture comes to us in the form of advanced allied health practitioners which is currently in the recruitment process and this opens yet another door to the advanced practice house.

However, fundamental to all of these roles, is the definition of advanced practice and the demonstration of this achievement. For the first time, this area of healthcare is firmly on the Scottish political agenda with the Chief Nursing Officer’s Transforming Nursing Roles programme providing the following agreed definition for an ANP role:

  1. An Advanced Nurse Practitioner (ANP) is an experienced and highly educated Registered Nurse who manages the complete clinical care for their patient, not solely any specific condition. Advanced practice is a level of practice, rather than a type or speciality of practice.


  1. ANPs are educated at Masters Level in advanced practice and are assessed as competent in this level of practice. As a clinical leader they have the freedom and authority to act and accept the responsibility and accountability for those actions. This level of practice is characterized by high level autonomous decision making, including assessment, diagnosis, treatment including prescribing, of patients with complex multi-dimensional problems. Decisions are made using high-level expert knowledge and skills. This includes the authority to refer, admit and discharge within appropriate clinical areas.


  1. Working as part of the multidisciplinary team ANPs can work in or across all clinical settings, dependent on their area of expertise.


Advanced nursing has 4 pillars of practice which ANP’s must have as part of their core role and function and although the primary focus is on clinical practice, all 4 practice pillars must be demonstrated. These are:

  • Clinical practice
  • Leadership
  • Facilitation of learning
  • Evidence, research and development.

The demonstration of achievement of the pillars of practice and consequently the ANP role has also been clearly defined at national level and this involves the outlining of professional competencies, participation in effective clinical supervision and meeting robust continuous personal development. Within NHSD&G Acute & Diagnostics Directorate, the value placed upon this level of practice has been highlighted by the appointment of an ANP clinical manager to deliver this national agenda in a cohesive, collaborative and joined-up way across NHSDG to ensure we are meeting our strategic responsibilities within this national framework.

Both nationally and locally, discussion and debate has taken place on the differences between advanced and specialist practice and as these nursing roles have progressed, differences and similarities have become evident. This is a wide-ranging area for debate encompassing all aspects of specialist practice but it is worthwhile to clarify that advanced and specialist practice should not be seen as directly hierarchical relationships; advanced nursing is not more senior than specialist and the reverse is equally applicable. Both levels of practitioners function at an extremely high level of practice, but with very different clinical focuses.

In summary therefore, it is obvious that advanced practice has evolved over a significant period of time and has ‘proved its worth’ in a number of healthcare areas with significant benefits for the delivery, safety and quality of patient care. Even though this concept has been fairly consistently on the agenda, the momentum around the role, its function and the measures of achievement and effectiveness has significantly gathered pace over the last 10 years with a further ‘injection’ since the implementation of Transforming Nursing Roles. This galloping horse (it is Ascot Week after all!) will only gather pace as more healthcare professionals such as physiotherapists, dieticians, pharmacists to name but a few, begin to realise the potential for their own advanced roles. This can only be a good thing with advanced practitioners now able to drive their own development whilst clearly evidencing their clinical confidence and competence for a discerning public who, quite rightly expect the best.

Exciting times ahead – are you ready to jump aboard?

Barbara Tamburrini is the ANP Clinical Manager

Being Carer Positive by Lesley Bryce

Lesley 3This week (12-18th June 2017) is Carers Week.

Carers week is a national awareness week that celebrates and recognises the vital contribution made by people across the UK who currently provide unpaid care.

A Carer is someone of any age who provides unpaid help and support to a relative, friend or neighbour who cannot manage to live independently without the Carer’s help due to frailty, illness, disability or addiction (Scottish Government 2016).

The focus this year is on building communities which support Carers to look after their loved ones well, while recognising that they are individuals with needs of their own.

3 in 4 carers don’t feel their caring role is understood or valued buy their community.    (

In Scotland, there are at least 759,000 Carers aged 16 or over and 29,000 young carers. The value of care provided by Carers in Scotland is £10,347,400,000 a year. Unpaid Carers are the largest group of carers in Scotland, providing more care than the NHS and council combined. Carers should be seen as a vital and valued part of our health and social care system. Three out of 5 of us will become Carers at some stage in our lives and I in 10 of us is already fulfilling some sort of caring role.


In Dumfries and Galloway, unpaid Carers provide over half of all care required, approximately 410,000 hours per week. There are 14,995 Carers in D&G (2011 census) although the figures are likely to be significantly higher as many people do not identify themselves as a Carer. Latest figures reveal that Carers in D&G make up 10% of the population and of this group, 29% provide more than 50 hours of support a week.

NHS Dumfries & Galloway recognise the important role that Carers play in our community and are determined to ensure that staff who have an unpaid caring role are supported to manage their own caring responsibilities with confidence and good health, whilst remaining in work.

One in five Carers give up work to care ( I gave up my employment when my son was 4. I returned to work after a long break. I personally know how much of a struggle it can be to juggle work and caring responsibilities and the effect this can have on your own health and well-being. I also understand the impact that giving up work can have on your personal finances and self- esteem.

lesley 2Most of you will know that NHS Dumfries & Galloway were successful in achieving the Carer Positive engaged award in 2016. Carer Positive provides a framework around which employers can develop and implement positive working environments which support staff who are unpaid Carers. NHS Dumfries is moving forward with our Carer Positive journey to improve and progress to established level. We are working in partnership with D&G Council and the Third Sector to embed a culture of support for Carers across the health and social care partnership.

During Carers Week, there has been lots of activities to support Carers including those in the workplace.

Arrangements have been made to promote the Special Leave Policy via workforce briefings and intranet flash ads so look out for these.

Carers Leave for NHS D&G is detailed in the Special Leave Policy which can be accessed from the BEACON intranet pages. If you do not have access speak with your manager in the first instance or contact a member of the Workforce Directorate team.

The new Carers information ‘z’ card is being promoted soon so look out for these 😊

Carer online training modules are available to all staff on learnProNHS (under the CPD tab) and through the Open University Open Learn platform. It includes NES EPiC levels 1-3. NES in partnership with the Open University in Scotland have developed Caring Counts in the Workplace. This is an online course for managers and policy makers. The course sits on the OU’s free Open learn platform, with a link from the EPiC e-learning site.


I am one of the Carer stories in this web based learning and it really shows how far I have come when I look back on the last 4 years. From that pilot with the Open University, I went back to UWS then I got a role on the board as a Non- Executive Director where I am also proud to be the Carers champion.

I know that it is exhausting sometimes having caring responsibilities and working and it has certainly helped me to have support to continue in my role.

Lesley 1The Hospital Carers project offers support and advice. It is based in the centre opposite the lifts in the main entrance lobby at DGRI where you can also find their Carer’s Week information display.  You can contact Lindsay sim or Jennifer Cranmer on 01387 241384.

Dumfries and Galloway Carers centre provides information, advice and support to anyone who cares for a relative or friend. They can be contacted on 01387 248600 or email . The centre has been an invaluable lifeline to me for the last 15 years.

The current Dumfries and Galloway Carers Strategy expires in 2017.Following consultation with Carers, Carers organisations and partners, a draft strategy has been developed for 2017-2021.The consultation closes on 30th June 2017. Here is the link:

For more information or assistance to complete the survey, please email or phone 01387-246941. Hard copies are available on request.

If you are a staff member who is a Carer and would like to be involved in Carer Positive, please feel free to get in touch. Please contact Philip Myers, Health and Wellbeing Specialist ( or Larel Currie, Commissioning Officer, Joint Strategic Planning and commissioning (

Lesley Bryce is a Non Executive member of NHS Dumfries and Galloway Health Board



Eat Fact, not Fiction….by Laura King

Laura K 1Barely a week passes without headlines (or Twitter trends) about diets and how to lose weight, improve your energy levels / skin/ hair / libido / life expectancy. Often these are contradictory and can lead to confusion. Whenever the headline suggests that a fad diet or miracle food is the holy grail that will solve all our health problems alarm bells should ring!

Dietitians are trained to examine the evidence behind such claims and sift out the facts from the fanciful. Unlike many medical trials where a drug is tested for effectiveness (usually against a placebo), nutrition trials are usually more complex and difficult to interpret. Mainly because nearly everybody eats, and people’s baseline diets and habits are so varied it makes it difficult to isolate the effect of altering one aspect of the diet.

We also consider the person as a whole and aim to prioritise dietary aims. An example of this is a referral that came through recently for a lady in her 80’s who wanted advice for diverticular disease and type 2 diabetes. When we saw her, it became evident that she had lost a considerable amount of weight since losing her husband. We were able to explain to the patient and her family that this was the greatest nutritional risk to her so we would encourage her to prioritise eating a little of what she fancied to try and boost her weight rather than follow a restrictive diet for her other conditions, particularly while she was an inpatient when we know that people are vulnerable to malnutrition.

As part of the fourth annual Dietitians Week being held June 12-16, the BDA and dietitians in Dumfries & Galloway are encouraging the public to get their advice on diet from the properly qualified experts. The public should also ensure any diet plan they follow is based on scientific evidence. Some of the advice given in relation to fad diets is not just ineffective, it can actually be harmful to people’s health.

Evidence-based nutrition advice is important because often the trials that are reported may be based on small, specific experiments and the results may not translate easily to real life or real people. Dietitians can interpret the evidence and help people make adjustments that fit into their lifestyle and are sustainable.

Eg. There is evidence that eating large quantities of soya can reduce cholesterol, but for the majority of people, having large quantities of soya-based products for breakfast, lunch, dinner and snacks is not going to be an achievable goal.

Laura K 2Dietitians Week

Annually, the BDA run a weeklong event called Dietitians Week, aiming to promote the importance of dietitians and the great impact they can have on the nation’s health and wellbeing. This year the week runs from 12-16 June and is taking the theme of Evidence and Expertise and you will spot our myth-busting displays around DGRI. This is to promote the importance of ensuring that dietary and nutrition advice comes from evidence-based sources, whilst highlighting the risk of following guidance that is not scientifically credible.

Please take time to look at our displays next week and when you see us out and about in the hospital, grab us for a chat about nutrition, fad diets and separating the fact from fiction.

Laura King is Lead Acute Dietitian at NHS Dumfries and Galloway

What Matters to You? by Alice Wilson (& many others!)

“What matters to you?” day is on 6th June and you may have seen information about it around the place. We are encouraged to think about what matters to us and to have conversations with individual service users, their families and our colleagues about what matters to them, so we can use that information to improve the care and support we give to individuals and their families and promote a healthy working environment.

I thought it would be an idea to focus this blog on people who work in our health and care system and asked them to share what matters to them in and out of work and to share a few photos if they wish. I am grateful to those people who have shared what matters to them. Thank you, this blog is yours:


Emma Jackson is a physiotherapist at Newton Stewart Hospital:

In work

Up to date handovers and good communication between staff

Being able to build trusting relationships with patients by using appreciative inquiry, and having the time to get to know them as a person

Out of work

Being able to spend quality time with my family, friends and pets

Having personal goals to work towards

– Being able to get outside as often as possible – walking in long grass with my dogs is my fix

boris and finn 


Morag McMinn, support services assistant, Gerry McDermott, support services manager, Kay Shepherd, support services supervisor

Liz Jardine, support services assistant, Linsey Wharram, support services assistant, Helen McCaig, support services assistant


Morag McMinn:

In work

To come into work and not get hassle.

That staff get things right, especially the care and the care of people with dementia

Out of work

My two granddaughters


Gerry McDermott:

In work

My staff feel respected and part of the whole network of the NHS

Out of work

My kids and the football (Celtic FC)

The kids are growing up fast and I want them to fulfil their dreams

CFC has fulfilled its dreams this year!

G. McDermott & Kids

G. McDermott & Son

Kay Shepherd:

In work

Staff are happy and get on well, there is mutual respect

Staff trust me to come and speak to me


Out of work

My four kids – my weans

my wains!!

Liz Jardine:

In work

It’s all about the patients; I enjoy talking to them and being part of the team

Being able to go to the supervisors and talk to them

Being happy in work


Out of work

My two sons and spending time with my husband as well as my wider family.

Supporting our sons to achieve in life

Lynsey Wharram:

In work

Being involved with the patients, additional responsibility is a privilege, such as taking people on their last journey to the mortuary

Being part of the team, uniform colours don’t matter

Out of work

My wee brother (Murrey) and people now recognising disability more

Proper training for people about disability and dementia



Helen McCaig:

In work

To come to work and being happy working

Being part of making patients feel their privacy is respected

Out of work

My husband and son – we are really proud of our son who is now doing his Masters at

Cambridge University

My cat, Salem

Helping my father who has dementia



Pictured: Jeanie Gallacher and Stephanie Phillips, Primary Care Mental Health Liaison, Stewartry. Norma Cunningham, Community Mental Health Team Support Worker, Stewartry.


Jeannie Gallacher & Stephanie Phillips

In work

As staff working within a new project in Primary Care Mental Health Liaison, it matters to us that patients feel they can have quick access to appropriate mental health treatment.  It matters to us that we forge good working relationships with our colleagues and that the service we provide is supportive and effective.

Out of work

Jeanie –   I feel it is important to have lots of quality time with my family and it matters to me that we try to get away for family days out and holidays!

Stephanie – It’s important to me in my home life that my family are healthy.  I enjoy walking my dog every day and this matters to me.


Norma Cunningham: 

In work

Firstly what matters to me is that I provide a good service to our patients.

It also matters to me that staff feel valued and encouraged to reflect and develop, and that staff receive positive feedback when there have good outcomes for patients.

Out of work

I have learned that it is not what you have in life but who you have in your life. My life is richer for having a family to love, grand children to cherish, friends you can rely on and pampered pets.


Grecy Bell is a GP and Deputy Medical Director in Primary Care



In work

Team work, having a shared understanding of each other’s role and common goals


Out of work

Having time to enjoy shared memories with family and friends




Linda Williamson is a General Manager in Women Children & Sexual Health

Linda has a pictorial creation, representing her in work and out of work “what matters to me”

Linda W


Then there’s me:

Alice Wilson, Deputy Nurse Director

In work

Being able to see the impact of my work on individuals and teams

Knowing that what I do makes a positive difference to the people we care for and their families

Being proud of my profession

Out of work

Spending time with my family and friends and living in a lovely place which feels a million miles away from the hustle and bustle of work. I’m part of a big family and a small community – ideal

Knowing (through whatever means necessary!) that someone will make sure I have nice shoes even when I am no longer able to walk in them!


Pictured: the view I see every day from the front of my house…it is amazing even at the close of the day – the bike is just there to fool you into thinking that’s the only mode of transport I use!

On 6th June and every other day, take a minute to think about what matters to you and ask yourself if you know what matters to your colleagues and those people you care for and support; if not, why not ask them?

Alice Wilson is Deputy Nurse Director at NHS Dumfries and Galloway

What a waste! by Dot Kirkpatrick

It cannot have escaped your attention that the media has been writing about food waste. The Guardian recently reported the latest figures, showing that UK households are throwing away £13bn of food each year. This equates to 7.3m tones of household food waste. Of this, 4.4m tones were deemed to be avoidable. This set me thinking about my own food waste. I can honestly state that apart from the occasional out of date yogurts caused “buy” 2 packs for £3 scenario, I either cook and freeze or make the ingredients into soup! I am not precious about sell by dates unless associated with a dairy product, fish or chicken, apart from when I am having people for dinner! I can’t be poisoning the guests? A plaque in my kitchen states… “Many people have eaten here and lived!”

Dot 2This brings me around to the purpose of this blog. Medicines waste. I feel a bit of a turncoat as I have given many a presentation clearly stating that you cannot compare the difference between Kellogg’s cornflakes and a supermarket cheaper own brand with branded drugs and their generic equivalent. However in this instance there is an analogy.

A report by the Department of Health estimates that unused medicines cost the NHS around £ 300 million every year, with an estimated £ 110 million worth of medicines returned to pharmacies, £90 million worth of unused prescriptions being stored in homes and £50 million worth of medicines disposed by Care Homes.

These figures don’t even take into account the cost to patient’s health and well being if medications are not being correctly taken. If medicines are left unused, this could lead to worsening symptoms and extra treatments that could have been avoided.

Due to the complexity of the causes of medicines wastage, a multifaceted and long-term approach across all healthcare sectors is required including partnership working with third sector organisations, public health, voluntary groups and local councils.  Coming to a surgery, pharmacy, library, council office near you soon, will be posters(designed and printed by our local council)  letting you know that each year in Dumfries & Galloway, we waste £3m worth of medicines of which over half is avoidable.  Look out also, for twitter feeds, Facebook postings and press releases. The posters and social media messages will attempt to engage with the public on how we can work together to reduce medicines waste. Simple tips such as “Only order what you need”; “Check before ordering”; “Don’t stockpile medicines” will feature in our waste campaign. With £3m required to be saved from our drugs budget this year, we cannot afford to ignore the unnecessary cost of waste.

Dot 1Waste campaigns have been featuring on the Prescribing Support Team’s remit for many years. There was Derek the Digger whose sole purpose in life was to pick up medicines waste by the ton. Then there was our Big Red Bus Campaign. We had a range of items with catchy slogans e.g. erasers stating “Wipe out Medicines Waste”. Last but not least was our ferret, carrying a bag of drugs out of which coins were leaking and going down a drain This time our Waste Campaign will be ongoing. The posters will change, the messages will vary but our mission will stay the same. Medicines cost money and we do not have an endless supply of resources. We need to use our allocated funding for medications where it will benefit patients by improving health outcomes.

And back to the analogy. I must admit that my husband randomly buys jars of chutney despite having adequate supplies in the cupboard. There are far worse faults and I can live with that.  I however know what is in my fridge/cupboards/freezer and so I don’t stockpile resulting in wasting food supplies. I think what I need, I buy what is necessary and I don’t buy items that I don’t want. Simple no waste!

It is everyone’s responsibility to promote the messages around using medicines responsibly and I hope we can rely on your support by promoting our campaign.

Dot Kirkpatrick is a Prescribing Support Pharmacist at NHS Dumfries and Galloway

I walk and cycle to work because I’m lazy by Rhian Davies

It’s true, I’m lazy. If I didn’t travel on foot or by bike to work, the shops, the pub, I’d need to find the time, inclination and means to exercise. So I walk and cycle because it:

  • Gets me there

Walking is the oldest form of transport. In fact we’ve evolved to do it – having been walking around for about 1.9million years. Cycling has been a means of getting from A to B for nearly 200 years.

  • Gets me there quickly

No searching for car keys, waiting in traffic and finding parking spaces. A journey by bike in Dumfries takes about the same time as a journey by car. Walking or cycling on traffic free and quiet routes means I don’t get held up by queues and stay clear of road works.

Rhian 1

  • Saves time

No need to find time to get to the gym or go for a run as travel is my exercise. Most people say they would exercise more if they had the time. As I’m travelling anyway, that time is put to use as exercise time too.

  • Is enjoyable

Rhian 2The main thing for me is the fresh air, being outside and enjoying the wildflowers and wildlife that I see and hear, especially at this time of year. Winter has an upside too – no need to get up early to see a beautiful sunrise and the moonrises can be pretty spectacular too. I’ve also seen shooting stars on my way home from work. And despite what it feels like, it doesn’t rain that much! In fact, there’s a 95% chance of NOT getting rained on, on your way to work.

  • Is sociable

I often see people I know on the way and enjoy having a chat with them. Waving to the lollipop lady on the way to work or chatting with the nice man who walks his spaniel adds a little happiness to my day.

  • Is safe

The most recent figures from the Department of Transport show the fatality rate for pedestrians and cyclists is the same, with one death per 29 million miles walked or cycled. Looking at how many people were killed or seriously injured, it works out at one person for every 1 million miles cycled and one person for every 2 million miles walked.

  • Keeps me fit

The main difference compared to driving is that whenever you walk or cycle your health benefits, whereas remaining seated in a car does nothing to improve it. Typically I cycle to work, a 20 minute journey each way, which easily meets the guidelines for 150 minutes of moderate exercise a week.

  • Benefits people and planet

You only have to look at the news and you’ll see an almost daily report on worsening air pollution and the effect this is having on people and the environment. Walking and cycling isn’t the only way to tackle this problem but it is a difference we can make every day to the people and place we live.

  • Is easy to get parked

Rhian 3In my role as Active Travel Officer, I’m here to help anyone who is thinking of travelling by foot or by bike. I’m working with staff at DGRI, the new hospital, Crichton Hall and The Willows.

Over summer I’m running events including basic bike maintenance workshops, Essential Cycling Skills, information stalls on route finding and guidance on buying a tax free bike through Cyclescheme. Upcoming events are posted online and advertised in the core briefing and posters around DGRI, Crichton Hall and The Willows.

So if you’re feeling inspired come along to:

Bike Maintenance for beginners

Drop in session – not sure how to change an inner tube? Need to know how to check your bike is safe to ride? Find out how and have a go.
Monday 22 May and Friday 26 May: 12noon – 2pm and 4pm – 6pm

Venue: Garage 26, the hospital residences

Cyclescheme information stall

Come along to find information on applying for a tax free bike

Crichton Hall Canteen on Tuesday 23 May: 12 – 2pm

Essential Cycling Skills (Beginner)

Can’t remember the last time you’ve ridden, or feeling wobbly when you ride? This is the course for you. Please book here.
Part 1 Wednesday 24 May: 11.30am – 1pm, Part 2 Thursday 25 May: 11.30am – 1pm

Part 1 Monday 5 June: 5pm – 6:30 pm, Part 2 Tuesday 6 June: 5pm – 6:30pm

Meeting point: Garage 26, the hospital residences 

Essential Cycling Skills (Intermediate)

Are you happy cycling on quiet roads but not sure how to navigate roundabouts or junctions confidently? Then this is the course for you. Please book here.
Part 1 Wednesday 24 May: 5:30pm –7pm, Part 2 Thursday 25 May: 5:30pm –7pm

Part 1 Wednesday 7 June: 11am – 12:30pm, Part 2 Thursday 8 June: 11am – 12:30pm

Meeting point: Garage 26, the hospital residences 

Bike Security Marking

Thursday 1 June: 12 – 2pm and 4pm – 6pm

Meeting point: Garage 26, the hospital residences 

I also want to hear from you about what would help you get out and about on two feet or two wheels. Are there facilities or infrastructure improvements that would allow you to walk and cycle? Have you heard about electric bikes but never had a go on one? Just let me know!

Contact me on:

Mob: 07788336211

Tel:  01387 246246 EXT: 36821


Rhian Davies is an Active Travel Officer for NHS D&G

Lochar North

Crichton Hall

Bankend Road








Outpatient Parenteral Antimicrobial Therapy (OPAT) – from Cellulitis to Meningioma by Audrey Morris and Shirley Buchan

OPAT as a service has been in use in many countries for the last 30 years. It is a method of delivering intra-venous antimicrobial therapy in an outpatient setting, as an alternative to remaining an inpatient.

Preparation of a typhoid shot in the medical clinicThe advantages of providing this service for the patient means that they have a reduced hospital stay and can return home and rehabilitate in their own environment. In certain cases the patient can continue to work whilst receiving IV antimicrobial therapy therefore causing them minimal disruption to their daily life. Psychologically the patient feels happier, eats better, sleeps better and is more likely to recover quicker in their own home.

In DGRI the service started in 2012 under the “What if?” project. Its main aim at this point was treatment of non-complicated cellulitis leading to the reduction of patient admissions for short term IV antimicrobials. In the intervening years we have developed to become more involved with complicated infections requiring longer lengths of treatment i.e. up to 12 weeks of IV antimicrobials, but the patient is otherwise fit enough return home.

From January 2016 to the end of March 2017 we have released 1419 beds, an average of 3.2 per day. We have treated patients with Cellulitis, Osteomyelitis, Infected Joint Replacements, ESBL, UTI’s, Pseudomonas, Osteoradionecrosis, Lyme disease, Endocarditis, Discitis, Peripheral Vascular Disease, Actinomycosis, SAB, Urosepsis, E-Coli ESBL and Meningioma.


Why do we need OPAT?

In December 2015 a 30 year old man, who we will call John, was referred to us. He is a high functioning gentleman with Spina bifida who regularly competes in Shot Putt events, all over the World. He had been admitted 6 weeks previously with an infection of his hip. He was clinically improving and ready for home. His family were also keen for his discharge. On discharge John was keen to return to weekly training but due the nature of his infection this had to be put on hold. He attended the clinic daily for 12 weeks either at Dumfries or nearer his home at Castle Douglas Community Hospital, even attending on Christmas day. John had a Hickman line in-site and he decided that in order to assist us he would dress according to which lumen we were using, red top red lumen white top white lumen. He made a good recovery and was discharged from us a year ago. John still phones us now and again and had informed us he is back to full fitness, competing again and even throwing further than before. His one regret he told us, was that due to illness he was not selected for last year’s Paralympics but he is working hard to go the next event in 2020.
So why do we need OPAT? To give people like John an effective patient-focused service as good as inpatient care in an out-patient environment. Our aim is to provide patient centred care nearer to home. In some cases we train the patient or their relative/carer to administer IV antimicrobials in their own home, leading to increased independence and putting the patient at the centre of their own care.

Main aims of OPAT.

To provide a high quality efficient clinical service using robust pathways, guidelines and protocols.
Reduce inpatient time and therefore reduce the risk of hospital acquired infections.
Develop the service to meet the changing demands on an overstretched service. With the opening of the new hospital imminent and the call for care nearer to home OPAT can help reduce demands on beds.
image3Improved quality of life for patients. They eat better, sleep better and generally feel better in the own home environment.
Increase patient involvement in delivery of care, continuity of care and communication.
Provide ongoing support at home and utilise a pathway for re-admission if required.
Reduce the length of inpatient stays therefore utilising acute beds more efficiently.
Structured pathway from referral to discharge.
Staff development.

Patient journey from Inpatient to OPAT patient.

We aim to make the transition from inpatient to OPAT patient as quick and painless as possible but have to follow guidelines. Once a patient has been identified by their Consultant as a potential OPAT patient the first step is to complete an SBAR referral form (In Beacon use ‘search for document’ option). On receipt of this we visit the patient to assess them and their needs for OPAT. There are certain criteria which must be met but these are listed on our SBAR referral form and should be considered prior to referral.
The patient is then seen by our Consultant and the OPAT nurse team. If they are suitable and want to become an OPAT patient then the discharge process can begin.
So in summary OPAT provides patient centred care led by a small dedicated team. It clearly reduces the length of inpatient stays, which can be from 2 days to 12 weeks. Patients are very much involved in the method of delivery of their care, they can opt to be trained to do it themselves at home or we try to deliver care as near to their home as possible. We work around their commitments e.g. an elderly patient who has carers in the morning can get a later appointment or in the case of the patient who continues to work we can see them early in the morning to allow then to get to work. Patients feel better at home, they sleep better, eat better and psychologically feel better. They are more in control of their treatment and have continuity of care.

In the words of one of our patients we “made a bad situation better”.


Audrey Morris & Shirley Buchan are Clinical Nurse Specialists in the OPAT team.