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 May;67(5): 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 CXHIOWSouthampton No pts TeamCNS ID physician Pharmacy CNS Pharmacy Microbiologist AMU team Microbiologist Pharmacy AdminDN (self, hosp) DN (hosp) Hospital Private Respiratory AccessPICC (hickman/ca nnula) Midline Cannula 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 Cure Improved Treatment failure Indeterminate Adverse reactions Leder et al, 1998 (ref 6) Patient Infection Outcome Cure / Improved / Failure OPAT Outcome Success / Partial success / Failure of OPAT Indeterminate Outcome readmission due to unrelated event OPAT Project Database

Summary  Chapman AL, et al. J Antimicrob Chemother May;67(5): Epub 2012 Jan 31  5 KEY AREAS  OPAT 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.

Charing Cross OPAT service 2007 to 2010

OPAT services CXHIOWSwindonSouthampton No pts TeamCNS ID physician Pharmacy CNS Pharmacy micro AMU team Microbiologist AdminDN (self, hosp) DN (hosp) Hospital Private Respiratory AccessPICC (hickman/ve nflon) Midline venflon Midline, PICC, venflon