Intended for healthcare professionals


The BMJ Awards 2018: Innovation

BMJ 2018; 361 doi: (Published 06 April 2018) Cite this as: BMJ 2018;361:k1522
  1. Nigel Hawkes, freelance journalist
  1. London, UK
  1. nigel.hawkes1{at}

The nominated teams have challenged convention and developed novel ways to improve patient care, reports Nigel Hawkes

Teaching videos and model arm

Many patients discharged from hospital continue to need antibiotic therapy delivered through a line in their arm, usually by a community nurse. “It’s quite a big and diverse group of patients,” says Emma Nickerson, consultant in infectious diseases at Addenbrooke’s Hospital in Cambridge. “It includes people who’ve had hip or knee implants that have become infected, those with abscesses or chronic lung conditions, some kidney infections, and people who’ve been in road traffic accidents and have metal implants. A quarter of that group develop infections.”

Access to community nurses is patchy, and it’s expensive, she says. So, she has extended the use of self administration, in which selected patients are taught to mix and administer their own antibiotics daily. The patients are seen once a week in the clinic, but for the rest of the time they are on their own.

Training was aided by the use of a model plastic arm, donated by Cambridge University clinical skills laboratory, on which patients could practise. Leaflets and videos were also produced. “It’s much more convenient for patients,” Nickerson says. “Typically, community nurses give a two to three hour window for their visits, so patients are trapped at home waiting. Self administration is much more convenient. They can go away for a weekend—it’s empowering.”

The project increased self administration by 70% and saved over £5m in the first year, when 212 patients were taught. Some needed antibiotics three times a day, which would have cost £260 if delivered by a nurse. Patients are delighted by it and become quite expert. “One patient we had taught came back to clinic and picked up on a nurse doing it wrong.”

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