scholarly journals Safety of Nurse- and Self-Administered Paediatric Outpatient Parenteral Antimicrobial Therapy

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 761
Author(s):  
Shanthy Sriskandarajah ◽  
Brett Ritchie ◽  
Janet K. Sluggett ◽  
Jodie G. Hobbs and Karen J. Reynolds
Keyword(s):  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Models Of Care ◽  
Clinical Factors ◽  
Self Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Factors Associated ◽  
Infusion Device ◽  
Paediatric Outpatient ◽  
Compare And Contrast

This study aimed to compare and contrast the safety and efficacy of nurse- and self-administered paediatric outpatient parenteral antimicrobial therapy (OPAT) models of care and to identify clinical factors associated with documented adverse events (AEs). A total of 100 OPAT episodes among children aged between 1 month and 18 years who were discharged from hospital and who received continuous 24 h intravenous antimicrobial therapy at home via an elastomeric infusion device were included. All documented AEs from the case notes were reviewed by a paediatrician and classified as either major or minor. Multivariable logistic regression was used to determine associations between clinical factors and any AE. A total of 86 patients received 100 treatment OPAT episodes (49 self-administered, 51 nurse administered). The most commonly prescribed antimicrobial via continuous infusion was ceftazidime (25 episodes). Overall, an AE was recorded for 27 (27%) OPAT episodes. Major AEs was recorded for 15 episodes and minor AEs were reported in 14 episodes. The odds of an AE was increased in episodes with self-administration (adjusted odds ratio (aOR) 6.25, 95% confidence interval (CI) 1.44–27.15) and where the duration of vascular access was >14 days (aOR 1.08, 95%CI 1.01–1.15). Our findings suggest minor AEs may be more frequently reported when intravenous antimicrobials are self-administered via 24 h continuous infusions.

scholarly journals Clinic- and Hospital-Based Home Care, Outpatient Parenteral Antimicrobial Therapy (OPAT) and the Evolving Clinical Responsibilities of the Pharmacist

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 233
Author(s):  
Toni Docherty ◽  
Jennifer J. Schneider ◽  
Joyce Cooper
Keyword(s):  
Home Care ◽  
Antimicrobial Therapy ◽  
Hospital Setting ◽  
Medication Administration ◽  
Models Of Care ◽  
Transitions Of Care ◽  
Hospital Inpatient ◽  
Self Administration ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Wide Range

Clinic- and hospital-based home care describes models of care where services commonly associated with hospital inpatient care are provided at the patient’s home or in an outpatient or community-based clinic. Hospital in the Home (HITH), also termed Hospital at Home (HaH) in parts of Europe and America, is a common and important example of this type of care. Other examples include infusion centers, skilled nursing facilities (particularly in the USA), self-administration models (including home infusion services) and administration through outpatient or community clinics. Different models of HITH care are used internationally and these encompass a wide range of services. Medication administration, particularly outpatient parenteral antimicrobial therapy (OPAT), is an important element in many of these models of care. There is a key role for pharmacists since the provision of medication is integral in this model of patient care outside the hospital setting. Data on the growing importance of HITH and OPAT as well as the administration of medications suited to clinic- and hospital-based home care, including subcutaneous and intramuscular injectables, immunoglobulins and other blood fractions, cancer chemotherapy, total parenteral nutrition, biologicals/biosimilars, vasopressors and enzymes, using differing service models, are described. The pharmacist’s role is evolving from that involved primarily with dose preparation and supply of medications. Their clinical expertise in medication management ensures that they are an integral member and leader in these models of care. Their role ensures the safe and quality use of medicines, particularly across transitions of care, with the pharmacist taking on the roles of educator and consultant to patients and health professional colleagues. Activities such as antimicrobial stewardship and ongoing monitoring of patients and outcomes is fundamental to ensure quality patient outcomes in these settings.

scholarly journals P64 Implementation of a paediatric outpatient parenteral antibiotic therapy (p-OPAT) service at a specialist children’s hospital

2020 ◽  
Vol 105 (9) ◽  
pp. e39.2-e40
Author(s):  
Hannah Porter ◽  
Kate Stock
Keyword(s):  
Data Collection ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
List Type ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Paediatric Outpatient ◽  
Bed Days ◽  
One Year

AimThe aim of this project is to optimise patient care, enhance patient experience, improve antimicrobial stewardship and assist patient flow through the hospital.MethodData collection was conducted one day a week over five consecutive weeks. All eligible wards were visited. Patient medication charts were inspected to see if intravenous antimicrobials were prescribed and a patient - specific data collection form was then completed. All the patients that met the eligibility criteria to be put forward for OPAT referral were then considered from a clinical perspective by a paediatric consultant as to their suitability for OPAT or IVOST and discharge. If the patient was deemed suitable for an OPAT discharge or IVOST and discharge a decision was made as to what antimicrobials they would theoretically have been on when discharged home. The number of potential bed days saved was calculated as the number of days between the patients review by the consultant (ie the day of data collection) and the date of their discharge prescription from that episode of care.The following was examinedpercentage of patients with identified pathogenspercentage of patients that had received input from the ID teampercentage of patients that had received input from microbiologythe prevalence of antimicrobials prescribedthe location of the patient’s home residencepatient/parent willingness to go home on OPAT.The data for patient numbers and bed day savings was then extrapolated to 52 weeks in order to be indicative of one year.ResultsOver the five days, 66 patients were identified that met the exclusion criteria to be referred for OPAT or IVOST. After clinical consideration the consultant deemed 4 patients to be suitable for OPAT and 19 for IVOST and discharge which generated a potential bed day saving of 38 bed days. This was comprised of 17 days through providing IVAs via OPAT and 21 days from timelier IVOST and discharge of patients. Extrapolated to be representative of one year, this would be a bed saving to the Trust of 1, 976 bed days.ConclusionThe potential has been identified for the hospital to make considerable bed day savings through the investment in an extended antimicrobial stewardship programme and establishment of a paediatric OPAT service. A business case has been submitted to the hospital board for consideration, with the hope that the service will be funded for a six month probationary period in order to assess its impact over the winter months, when demand for beds and pressures on PICU and theatres are highest.ReferencesPatel S, et al. 2015. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement. Journal of Antimicrobial Chemotherapy2015;702:360–373.Carter B, et al. Delivery, setting and outcomes of paediatric outpatient parenteral antimicrobial therapy (OPAT): a scoping review. BMJ Open, 2018;8:e021603.Hodgson KA, et al. The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Archives of Disease in Childhood, 2016:10:886–893.Knackstedt ED, et al. Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship. Infection Control & Hospital „Epidemiology 2015:36:222–224.

scholarly journals Maximising the opportunity of a self‑administration outpatient parenteral antimicrobial therapy pathway

2021 ◽  
Vol 15 (1) ◽  
pp. 15-23
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Patient Questionnaire ◽  
University Hospitals ◽  
Self Administration ◽  
Patient Response ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Nurse Empowerment ◽  
The University ◽  
The Impact

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.

scholarly journals Paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): An e-survey of the experiences of parents and clinicians

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249514
Author(s):  
Bernie Carter ◽  
Debra Fisher-Smith ◽  
David Porter ◽  
Steven Lane ◽  
Matthew Peak ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Tertiary Hospital ◽  
Parental Satisfaction ◽  
Hospital Data ◽  
Family Routines ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Open Questions ◽  
Home Based ◽  
Parents And Children ◽  
Paediatric Outpatient

Background Little evidence exists about parental satisfaction and their influence on referral to paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT). Aim This study aimed to examine the experiences of parents, children and clinicians of OPAT at a large tertiary children’s hospital. Method A prospective e-survey, using closed and open questions, of parents (n = 33) of 33 children who had received OPAT (3 children completed a survey), and clinicians (n = 31) involved in OPAT at a tertiary hospital. Data were collected September 2016 to July 2018. Results Data were analysed using simple descriptive statistics. The results show that OPAT offered benefits (less stress, re-establishment of family life) compared to hospital-based treatment for parents and children, although some were anxious. Clinicians’ referral judgements were based on child, home, and clinical factors. Some clinicians found the process of referral complex. Conclusion Most parents and children were satisfied with the OPAT service and preferred the option of home-based treatment as it promoted the child’s comfort and recovery and supported family routines.

scholarly journals Adverse Events and Healthcare Utilization Associated With Outpatient Parenteral Antimicrobial Therapy Among Older Versus Younger Adults

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Kaylen Brzozowski ◽  
Rupak Datta ◽  
Joseph Canterino ◽  
Maricar Malinis ◽  
Manisha Juthani-Mehta
Keyword(s):  
Adverse Events ◽  
Confidence Interval ◽  
Healthcare Utilization ◽  
Antimicrobial Therapy ◽  
Odds Ratio ◽  
Rate Ratio ◽  
Adjusted Odds Ratio ◽  
Incidence Rate Ratio ◽  
Younger Adults ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Among older (n = 204) versus younger (n = 253) adults, there was no difference in adverse events (adjusted odds ratio [aOR] = 0.98; 95% confidence interval [CI] = 0.6–1.6) or healthcare utilization (incidence rate ratio = 1.09; 95% CI = 0.9–1.3) within 30 days after discontinuing outpatient parenteral antimicrobial therapy. Vancomycin (aOR = 1.92) and oxacillin (aOR = 3.12) were independently associated with adverse events.

Dedicated paediatric Outpatient Parenteral Antimicrobial Therapy medical support: a pre–post observational study

2017 ◽  
Vol 103 (2) ◽  
pp. 165-169 ◽  
Author(s):  
Ariel O Mace ◽  
Charlie McLeod ◽  
Daniel K Yeoh ◽  
Julie Vine ◽  
Yu-Ping Chen ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Best Practice ◽  
Medical Team ◽  
Medical Support ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Best Practice Guidelines ◽  
Paediatric Outpatient ◽  
Observational Cohort ◽  
The Many ◽  
The Impact

ObjectiveDespite the many benefits of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT) programmes, there are risks associated with delivering inpatient-level care outside of hospital. There is a paucity of evidence defining how best to mitigate these risks. We examined the impact of introducing a dedicated medical team to OPAT, to define the role of increased medical oversight in improving patient outcomes in this cohort.DesignA prospective 24-month pre–post observational cohort study.SettingThe Hospital in the Home (HiTH) programme at Princess Margaret Hospital (PMH) for Children, Western Australia.PatientsAll OPAT admissions to HiTH, excluding haematology/oncology patients.InterventionsPMH introduced a dedicated OPAT medical support team in July 2015 to improve adherence to best-practice guidelines for patient monitoring and review.Main outcome measuresDuration of OPAT, adherence to monitoring guidelines, drug-related and line-related adverse events and readmission to hospital.ResultsThere were a total of 502 OPAT episodes over 24 months, with 407 episodes included in analyses. Following the introduction of the OPAT medical team, adherence to monitoring guidelines improved (OR 4.90, 95% CI 2.48 to 9.66); significantly fewer patients required readmission to hospital (OR 0.45, 95% CI 0.24 to 0.86) and there was a significant reduction in the proportion of patients receiving prolonged (≥7 days) OPAT (OR 0.67, 95% CI 0.45 to 0.99).ConclusionThe introduction of a formal medical team to HiTH demonstrated a positive clinical impact on OPAT patients’ outcomes. These findings support the ongoing utility of medical governance in a nurse-led HiTH service.

Maximising the opportunity of a self-administration outpatient parenteral antimicrobial therapy pathway

2021 ◽  
Vol 30 (2) ◽  
pp. S4-S10
Author(s):  
Jake Bodycot ◽  
Linda Mashonganyika ◽  
Nicola Kucziw ◽  
Chanelle Ingham ◽  
Samira Bhukera ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Patient Questionnaire ◽  
University Hospitals ◽  
Self Administration ◽  
Patient Response ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Nurse Empowerment ◽  
The University ◽  
The Impact

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.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography 

2021 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

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.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

2020 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.Conclusions Our findings suggest that age, number of fused segments, the presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

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