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 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

Net zero carbon: Energy performance targets for offices

2021 ◽  
Vol 42 (3) ◽  
pp. 349-369
Author(s):  
Robert Cohen ◽  
Karl Desai ◽  
Jennifer Elias ◽  
Richard Twinn
Keyword(s):  
Energy Efficiency ◽  
Minimum Energy ◽  
Energy Performance ◽  
Consultation Process ◽  
Net Zero ◽  
Extensive Consultation ◽  
Operational Energy ◽  
Legislative Framework ◽  
Zero Carbon ◽  
The Uk

The UKGBC Net Zero Carbon Buildings Framework was published in April 2019 following an industry task group and extensive consultation process. The framework acts as guidance for achieving net zero carbon for operational energy and construction emissions, with a whole life carbon approach to be developed in the future. In consultation with industry, further detail and stricter requirements are being developed over time. In October 2019, proposals were set out for industry consultation on minimum energy efficiency targets for new and existing commercial office buildings seeking to achieve net zero carbon status for operational energy today, based on the performance levels that all buildings will be required to achieve by 2050. This was complemented by modelling work undertaken by the LETI network looking into net zero carbon requirements for new buildings. In January 2020 UKGBC published its guidance on the levels of energy performance that offices should target to achieve net zero and a trajectory for getting there by 2035. This paper describes the methodology behind and industry perspectives on UKGBC’s proposals which aim to predict the reduction in building energy intensity required if the UK’s economy is to be fully-powered by zero carbon energy in 2050. Practical application: Many developers and investors seeking to procure new commercial offices or undertake major refurbishments of existing offices are engaging with the ‘net zero carbon’ agenda, now intrinsic to the legislative framework for economic activity in the UK. A UKGBC initiative effectively filled a vacuum by defining a set of requirements including energy efficiency thresholds for commercial offices in the UK to be considered ‘net zero carbon’. This paper provides all stakeholders with a detailed justification for the level of these thresholds and what might be done to achieve them. A worked example details one possible solution for a new office.

scholarly journals Consensus standards of healthcare for adults and children with inflammatory bowel disease in the UK

2019 ◽  
Vol 11 (3) ◽  
pp. 178-187 ◽  
Author(s):  
Rukshana Kapasi ◽  
Jackie Glatter ◽  
Christopher A Lamb ◽  
Austin G Acheson ◽  
Charles Andrews ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Quality Improvement ◽  
Bowel Disease ◽  
Care Delivery ◽  
Service Development ◽  
Term Care ◽  
Improvement Project ◽  
Adults And Children ◽  
Inflammatory Bowel ◽  
The Uk

ObjectiveSymptoms and clinical course during inflammatory bowel disease (IBD) vary among individuals. Personalised care is therefore essential to effective management, delivered by a strong patient-centred multidisciplinary team, working within a well-designed service. This study aimed to fully rewrite the UK Standards for the healthcare of adults and children with IBD, and to develop an IBD Service Benchmarking Tool to support current and future personalised care models.DesignLed by IBD UK, a national multidisciplinary alliance of patients and nominated representatives from all major stakeholders in IBD care, Standards requirements were defined by survey data collated from 689 patients and 151 healthcare professionals. Standards were drafted and refined over three rounds of modified electronic-Delphi.ResultsConsensus was achieved for 59 Standards covering seven clinical domains; (1) design and delivery of the multidisciplinary IBD service; (2) prediagnostic referral pathways, protocols and timeframes; (3) holistic care of the newly diagnosed patient; (4) flare management to support patient empowerment, self-management and access to specialists where required; (5) surgery including appropriate expertise, preoperative information, psychological support and postoperative care; (6) inpatient medical care delivery (7) and ongoing long-term care in the outpatient department and primary care setting including shared care. Using these patient-centred Standards and informed by the IBD Quality Improvement Project (IBDQIP), this paper presents a national benchmarking framework.ConclusionsThe Standards and Benchmarking Tool provide a framework for healthcare providers and patients to rate the quality of their service. This will recognise excellent care, and promote quality improvement, audit and service development in IBD.

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 Wessex Acute Frailty Audit: applying quality improvement methodology to design and implement a regional frailty audit using a collaborative, multiprofessional approach

2020 ◽  
Vol 9 (1) ◽  
pp. e000870 ◽  
Author(s):  
Lucy Anne Lewis ◽  
Teresa Corbett ◽  
Kerry Burrows ◽  
Claire Spice ◽  
Cheryl Davies ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Good Practice ◽  
Standards Of Care ◽  
Small Scale ◽  
Care Provision ◽  
Audit Tool ◽  
Face To Face ◽  
Regional Approach ◽  
Local Resources ◽  
The Uk

IntroductionAn acute hospital stay increases the risk of negative outcomes for those living with frailty. This paper describes the application of quality improvement methodology to design and implement a regional audit to gain an understanding of care provision.MethodsSmall scale tests of change (Plan–Do–Study–Act cycles) were used to design the audit structure and questions. Data collectors met face to face with 2–3 multiprofessional clinicians on 58 wards in 10 hospitals across the region, using an electronic tool to gather data. Outcomes were analysed manually in Excel by extracting from the electronic audit tool.Results58 wards across 10 hospitals participated in the audit, which identified three key themes: lack of awareness and frailty training outside medicine for older people specialties, and significant variability of both frailty identification and comprehensive geriatric assessment.ConclusionCombining quality improvement methodology with a collaborative, regional approach to design and implementation of a frailty audit creates a reliable tool ensuring all stakeholders are considering improvement from the outset. The results have facilitated an agreed regional approach on how best to use local resources to improve and standardise frailty care provision. By highlighting areas of good practice and significant gaps in frailty identification, personalised care planning and hospital wide provision of frailty training, this region of the UK will now be able to drive up standards of care.

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.

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