OPAT Standards

Chapman AL, Seaton RA, Cooper MA, Hedderwick S, Goodall V, Reed C, Sanderson F, Nathwani D; on

behalf of the BSAC/BIA OPAT Project Good Practice Recommendations Working Group. J Antimicrob

Chemother. 2012 May;67(5):1053-1062. Epub 2012 Jan 31

Good Practice Recommendations for Outpatient Parenteral Antibiotic Therapy (OPAT) in Adults in the UK: a consensus

statement

Why?

Expansion of OPAT services in the UK Huge variation in

service models and quality degrees of clinical supervision outcome monitoring

Provide care ‘that is equal to inpatient care, if not superior’ (1998 UK consensus statement)

Aims

• pragmatic guidance on the development and delivery of OPAT in the UK, whatever the setting– resource for setting up new services– practical set of quality indicators for existing

services

• literature update

Joint initiative of BSAC and BIA

Process

• Working group established: wide range of disciplines

• Draft recommendations (May 2010) based on existing standards (1998 and IDSA) and experience

• Literature review 1998-June 2010• Abstracts screened and 615 papers divided

into 5 key areas• Revision of recommendations based on

literature review• Presentation at BSAC OPAT European

Summit (March 11)• National consultation (Autumn 2011)• E publication January 2012

5 key areas

1. OPAT team and service structure 2. Patient selection 3. Antimicrobial management and drug

delivery 4. Monitoring of the patient during OPAT 5. Outcome monitoring and clinical

governance

OPAT services

CXH IOW Southampton

No pts 2010

200 45 300+70+80

Team CNSID physicianPharmacy

CNSPharmacyMicrobiologist

AMU teamMicrobiologistPharmacy

Admin DN(self, hosp)

DN(hosp)

HospitalPrivateRespiratory

Access PICC(hickman/cannula)

MidlineCannula

Midline, PICC, cannula

1. OPAT team and service structure

• Identifiable lead clinician (with time in job plan)

• Multidisciplinary team (clinician, consultant in infection – ID/micro, specialist nurse, pharmacist)

• Clear management plan for each patient• Shared clinical responsibility between the

referring clinician and the OPAT clinician unless otherwise agreed

• Clear lines of communication between the OPAT team, the patient’s GP and the referring clinician

2. Patient selection

• Infection-related inclusion/exclusion criteria, including infection-specific severity criteria

• OPAT patient criteria (physical, social and logistic)

• Initial assessment should be performed by doctor and OPAT nurse

• Patients and carers should be fully informed about OPAT

• Consider thrombo-prophylaxis for patients who were on this prior to OPAT

3. Antimicrobial management/delivery

• Infection specialist responsible for agreeing treatment plan (agent, frequency, duration)

• OPAT team responsible for– Continued and correct prescription – with review by

antimicrobial pharmacist– Choice of VAD– Selection of drug delivery device

• Care of VAD / storage, admin, delivery of drugs as per RCN

• Documentation of doses• Admin of first dose in setting where anaphylaxis treatable• Training and documentation of competence in self-admin

4. Monitoring of the patient during OPAT

• Patients with SSTI should be reviewed daily by the OPAT team

• Weekly MDT meeting to monitor response, AE, plan

• Patients should be regularly reviewed clinically by the OPAT team with infection specialist input. Frequency and type of reviews to be agreed locally

• Weekly blood tests, or twice monthly if stable

• Mechanism for urgent discussion of problems

• 24-hour access to advice / review / admission

5. Outcome monitoring and clinical governance

• Prospective data collection, ideally using a database

• Standard outcome criteria on completion of intravenous therapy

• Also record data on drug reactions, line problems, C diff and Staph aureus bacteraemia

• Risk assessments and audit• Regular surveys of patient experience• Ongoing CPD for OPAT team members

5. Outcome monitoring and clinical governance

US OPAT outcomes registry 1997-2001

Cure

Improved

Treatment failure

Indeterminate

Adverse reactions

Leder et al, 1998 (ref 6)

Patient Infection OutcomeCure / Improved / Failure

OPAT OutcomeSuccess / Partial success / Failure of OPAT

Indeterminate Outcomereadmission due to unrelated event

OPAT Project Database

Summary

Chapman AL, et al. J Antimicrob Chemother. 2012 May;67(5):1053-1062. Epub 2012 Jan 31

5 KEY AREASOPAT team and service structure Patient selection Antimicrobial management and drug

delivery Monitoring of the patient during OPAT Outcome monitoring and clinical

governance

Acknowledgments

• UK OPAT Project Steering group– Tracey Guise– Dilip Nathwani– Brian Ward

• Vittoria Lutje – literature search• Recommendations working group

– Ann Chapman– Andrew Seaton– Mike Cooper– Sara Hedderwick– Vicky Parker– Correine Reed

Excellent Service, very attentive and courteous staff.Should be done by health visitors as is difficult to get to hospital and also expensive, £16 a day on taxis, and very tiring.

I have every confidence in the Oat team at CXH. Not only are they excellent at their job but polite & considerate as well. The clinic seems to run like silk.Sinda was very kind and professional. The doctors were more readily available than while an inpatient & informative, supportive and again very good.

The care and professional service that I experienced from the first to the OPAT service has been of the highest order!Richard & Sinda were a great help, great form of treatment, much appreciated.

The outpatient staff have been wonderful and have kept me up to date with any changes or information that has arose.Nursing staff Richard & Sinda so very kind. Thanks.

Looked after very good.Thanks a lot. You were friendly and you've done all the best. I very much appreciate helping me.

I found that the staff and treatment to be 1st class, long may the service continue.Very friendly team, I was always welcomed and made to feel at ease during my treatment.

The knowledge, experience and professionalism exceeded all expectations. They are a credit to CXH/NHS.Very effective, both the hospital based team and the contractors have been very helpful and efficient.

The infection nurses (Richard & Sinda) were exceptional in the friendly/supportive care they gave.The staff were very friendly (especially Sinda). They made you feel at ease and were very professional at their job. Living nearby helped a lot.

Without doubt, an impeccable service. Extremely professional in every way.Very impressed.

Sinda and Richard are extremely professional people in a very difficult job. Very impressed.Very good, excellent staff.

The service received from Richard and Sinda was fantastic, they always went out of their way to make you feel comfortable during my visits. I found the help and treatment by the team to be first class.

All staff first class.Very good.

The kindness of the staff made me feel safe and cared for. Thank you.I am most grateful for all the care that I have received during my attendance at the clinic.

All OPAC team (Richard & Sinda) were extremely helpful, very reassuring when inserting/removing mid line, and most cooperative when answering queries and helping me with my anxieties. Thanks very much.Friendly and helpful. Very competent.

Fantastic service. Two very nice people.Thank you so much. Richard and Sinda you rock!

Service was great and easy to get hold of, if any issues arouse they sorted them out very quickly to the point I could still go on holiday whilst having IV antibiotics.OPAT was a flawless service and I have only positive comments.

The only thing that let the treatment down was the transport. If the transport stays the same I would not do OPAT again.Very difficult to contact over the phone at the required hour.

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patients 84 119 179

episodes 95 131 192

treatment days 2467 3216 3915

07/08 08/09 09/10

Charing Cross OPAT service 2007 to 2010

OPAT services

CXH IOW Swindon Southampton

No pts 2010

200 45 300+70+80

Team CNSID physicianPharmacy

CNSPharmacymicro

AMU teamMicrobiologist

Admin DN(self, hosp)

DN(hosp)

HospitalPrivateRespiratory

Access PICC(hickman/venflon)

Midlinevenflon

Midline, PICC, venflon