References
Maximising the opportunity of a self-administration outpatient parenteral antimicrobial therapy pathway
Abstract
Background:
The University Hospitals of Leicester NHS Trust outpatient parenteral antimicrobial therapy (OPAT) service has expanded rapidly with more nurse-led direction.
Aims:
A retrospective study between 1 July 2014 and 31 December 2019 was undertaken to assess the impact of OPAT expansion on beds released for further utilisation, clinical outcomes, adverse vascular access device (VAD) outcome, and self- and family-administered parenteral antimicrobial therapy.
Method:
Data were extracted from the OPAT Patient Management System and from a patient questionnaire survey.
Findings:
1084 completed patient episodes were recorded in 958 patients, rising from 39 episodes in 2014 to 265 in 2019. The number of beds released for further utilisation correspondingly rose from 828 in 2014 to 8462 in 2019. The proportion of patients/family members trained to self-administer rose from 25% to 75%, with clinical cure/improvement of infection remaining high at between 84.6% and 92.8% of patients annually. Serious adverse VAD events remained low throughout. The patient response was generally positive.
Conclusion:
Nurse empowerment within OPAT can lead to significant improvements and patient benefits, while maintaining clinical outcomes.
Outpatient parenteral antimicrobial therapy (OPAT) services enable patients who require intravenous (IV) antimicrobial therapy, but who are well enough to receive care outside of a hospital environment, to receive their treatment in the community. This may include self-administration of IV antimicrobials by the patient or a family member/carer or a nurse administering treatment in the patient's home or in a clinic setting.
Across the UK, the number of OPAT services is increasing (Durojaiye et al, 2019), helping to reduce hospital admissions, facilitate early discharge, reduce length of hospital stays, and provide cost-effective care closer to home (Chapman, 2013; Chapman et al, 2019). OPAT features in the NHS strategy for strengthening antimicrobial stewardship (Ashiru-Oredope et al, 2012) and the British Society for Antimicrobial Chemotherapy (BSAC) has a number of workstreams related to OPAT, including drug stability testing and a framework for practice (BSAC, 2021).
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