scholarly journals Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement

2012 ◽  
Vol 67 (5) ◽  
pp. 1053-1062 ◽  
Author(s):  
A. L. N. Chapman ◽  
R. A. Seaton ◽  
M. A. Cooper ◽  
S. Hedderwick ◽  
V. Goodall ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Consensus Statement ◽  
Good Practice ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Practice Recommendations ◽  
The Uk

scholarly journals Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Ann L N Chapman ◽  
Sanjay Patel ◽  
Carolyne Horner ◽  
Helen Green ◽  
Achyut Guleri ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Therapy ◽  
Good Practice ◽  
Service Evaluation ◽  
Consultation Process ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Practice Recommendations ◽  
Extensive Consultation ◽  
Adults And Children ◽  
The Uk

AbstractUK good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) were published in 2012 and 2015 for adult and paediatric patients, respectively. Here we update the initial good practice recommendations in a combined document based on a further review of the OPAT literature and an extensive consultation process. As with the previous good practice recommendations, these updated recommendations are intended to provide pragmatic guidance for new and established OPAT services across a range of settings and to act as a set of quality indicators for service evaluation and quality improvement.

scholarly journals Outpatient parenteral antimicrobial therapy: updated recommendations from the UK

2019 ◽  
Vol 74 (11) ◽  
pp. 3125-3127 ◽  
Author(s):  
Ann L N Chapman ◽  
Sanjay Patel ◽  
Carolyne Horner ◽  
Mark Gilchrist ◽  
R Andrew Seaton
Keyword(s):  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Good Practice ◽  
Intravenous Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Stakeholder Consultation ◽  
Practice Recommendations ◽  
Recent Developments ◽  
Adults And Children ◽  
The Uk

Abstract Outpatient parenteral antimicrobial therapy (OPAT) offers safe, effective and patient-centred care for adults and children. The OPAT UK good practice recommendations for adults and children have recently been updated through a process of literature review, expert consensus and extensive stakeholder consultation. Here we discuss the key changes in the updated recommendations in the context of recent developments, including novel antimicrobial agents and delivery devices, the place of oral antimicrobials as an alternative to intravenous therapy, new OPAT service models and the broader antimicrobial stewardship agenda.

scholarly journals A qualitative study of patients’ feedback about Outpatient Parenteral Antimicrobial Therapy (OPAT) services in Northern England: implications for service improvement

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019099 ◽  
Author(s):  
Maureen Twiddy ◽  
Carolyn J Czoski Murray ◽  
Samantha J Mason ◽  
David Meads ◽  
Judy M Wright ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Antimicrobial Therapy ◽  
Local Population ◽  
Health Centre ◽  
Service Improvement ◽  
Self Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Semistructured Interviews ◽  
The Uk ◽  
At Home

ObjectiveOutpatient parenteral antimicrobial therapy (OPAT) provides opportunities for improved cost savings, but in the UK, implementation is patchy and a variety of service models are in use. The slow uptake in the UK and Europe is due to a number of clinical, financial and logistical issues, including concern about patient safety. The measurement of patient experience data is commonly used to inform commissioning decisions, but these focus on functional aspects of services and fail to examine the relational aspects of care. This qualitative study examines patients’ experiences of OPAT.DesignIn-depth, semistructured interviews.SettingPurposive sample of OPAT patients recruited from four acute National Health Service (NHS) Trusts in Northern England. These NHS Trusts between them represented both well-established and recently set-up services running nurse at home, hospital outpatient and/or self-administration models.ParticipantsWe undertook 28 semistructured interviews and one focus group (n=4).ResultsDespite good patient outcomes, experiences were coloured by patients' personal situation and material circumstances. Many found looking after themselves at home more difficult than they expected, while others continued to work despite their infection. Expensive car parking, late running services and the inconvenience of waiting in for the nurse to arrive frustrated patients, while efficient services, staffed by nurses with the specialist skills needed to manage intravenous treatment had the opposite effect. Many patients felt a local, general practitioner or community health centre based service would resolve many of the practical difficulties that made OPAT inconvenient. Patients could find OPAT anxiety provoking but this could be ameliorated by staff taking the time to reassure patients and provide tailored information.ConclusionServices configurations must accommodate the diversity of the local population. Poor communication can leave patients lacking the confidence needed to be a competent collaborator in their own care and affect their perceptions of the service.

Providing community intravenous therapy during the COVID-19 pandemic

2021 ◽  
Vol 30 (19) ◽  
pp. S4-S12
Author(s):  
Paul Hodgkins
Keyword(s):  
Good Practice ◽  
Hospital Setting ◽  
Community Services ◽  
Intravenous Therapy ◽  
Parenteral Antibiotic ◽  
Practice Recommendations ◽  
Care Organisation ◽  
Primary Care Teams ◽  
The Uk ◽  
Therapy Service

Community intravenous therapy is well-established in most regions of the UK. Although there are national good practice recommendations detailing the service provision of outpatient parenteral antibiotic therapy (OPAT), examples of extended service delivery of other therapies are limited. This article describes the development of a community IV therapy service through integration with acute and primary care teams. IV therapies delivered in addition to antimicrobials safely outside of the hospital setting are also discussed with scope for future areas of development explored. The benefits of care closer to home for patients during the global COVID-19 pandemic are examined, as well as the potential for widening the whole gamut of practice for already established NHS community services through the development of integrated working in a local care organisation.

scholarly journals Paediatric Common Infections Pathways: improving antimicrobial stewardship and promoting ambulation for children presenting with common infections to hospitals in the UK and Ireland

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Carolyne Horner ◽  
Robert Cunney ◽  
Alicia Demirjian ◽  
Conor Doherty ◽  
Helen Green ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Good Practice ◽  
Severe Infection ◽  
Pleural Empyema ◽  
Peritonsillar Abscess ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infection Pathways ◽  
Diagnostic Approaches ◽  
The Uk ◽  
Common Infections

AbstractPaediatric common infection pathways have been developed in collaboration between the BSAC and national paediatric groups, addressing the management of cellulitis, lymphadenitis/lymph node abscess, pneumonia/pleural empyema, pyelonephritis, tonsillitis/peritonsillar abscess, otitis media/mastoiditis, pre-septal/post-septal (orbital) cellulitis, and meningitis. Guidance for the management of a child presenting with a petechial/purpuric rash and the infant under 3 months of age with fever is also provided. The aim of these pathways is to support the delivery of high-quality infection management in children presenting to a hospital. The pathways focus on diagnostic approaches, including the recognition of red flags suggesting complex or severe infection requiring urgent intervention, approaches to antimicrobial stewardship (AMS) principles and guidance on safe and timely ambulation aligned with good practice of outpatient parenteral antimicrobial therapy (OPAT).

scholarly journals Outpatient parenteral antimicrobial therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e049733
Author(s):  
Maria Dimitrova ◽  
Mark Gilchrist ◽  
R A Seaton
Keyword(s):  
Antimicrobial Therapy ◽  
Diabetic Foot ◽  
British Society ◽  
Oral Antibiotic ◽  
Self Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Diabetic Foot Infections ◽  
The Uk ◽  
Tract Infections ◽  
Delivery Models

ObjectivesTo compare costs associated with different models of outpatient parenteral antimicrobial therapy (OPAT) delivery with costs of inpatient (IP) care across key infection groups managed via OPAT in the UK.DesignA cost-minimisation design was used due to evidence of similarities in patient and treatment outcomes between OPAT and IP care. A bottom-up approach was undertaken for the evaluation of OPAT associated costs. The British Society of Antimicrobial Chemotherapy National Outcomes Registry System was used to determine key infection diagnoses, mean duration of treatment and most frequent antibiotics used.SettingSeveral OPAT delivery settings were considered and compared with IP care.InterventionsOPAT models considered were OP clinic model, nurse home visits, self (or carer)-administration by a bolus intravenous, self-administration by a commercially prefilled elastomeric device, continuous intravenous infusion of piperacillin with tazobactam or flucloxacillin with elastomeric device as OP once daily and, specifically for bone and joint and diabetic foot infections, complex outpatient oral antibiotic therapies.ResultsBase case and a range of scenario results showed all evaluated OPAT service delivery models to be less costly than IP stay of equivalent duration. The extent of savings varied by OPAT healthcare delivery models. Estimated OPAT costs as a proportion of IP costs were estimated at 0.23–0.53 (skin and soft-tissue infections), 0.34–0.46 (complex urinary tract infections), 0.23–0.51 (orthopaedic infections), 0.24–0.42 (diabetic foot infections) 0.40–0.56 (exacerbations of bronchiectasis) and 0.25–0.42 (intra-abdominal infections). Partial or full complex oral antibiotic therapies in orthopaedic or diabetic foot infections costs were estimated to be 0.13–0.26 of IP costs. Main OPAT costs were associated with staff time and antimicrobial medications.ConclusionsOPAT is a cost-effective use of National Health Service resources for the treatment of a range of infections in the UK in patients who can be safely managed in a non-IP setting.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

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