Background Outpatient parenteral antimicrobial therapy(OPAT) has been demonstrated to be safe and effective. Therefore, it has widespread application outside our country.
Purpose To set up a framework to establish and expand qualitative and safe OPAT care in a regional hospital.
Material and methods We conducted a literature analysis and a retrospective analysis (including pharmacoeconomics) of OPAT patients discharged from our hospital. In addition, we conducted a survey questioning healthcare providers’ points of view regarding OPAT. We questioned members of the antimicrobial management teams of 94 hospitals, physicians of our hospital and primary care providers in the hospital’s region. Based on the results, we developed a structured OPAT service supported by validated tools and information leaflets.
Results In 2015, we treated 77 OPAT patients in our 500 bed hospital, mostly for urinary tract, bone and joint, and genital tract infections, most commonly with ceftriaxone or temocilline. The majority of OPAT patients (74%) were treated in the day care hospital. The overall average duration of OPAT therapy was 11 days. 822 hospitalisation bed days were saved. The surveys revealed that despite acknowledgment of the benefits and potential of OPAT, there was only small scale application in hospitals. Lack of procedures, high costs for the patient and restrictive legislation regarding drug delivery were mentioned as the main drawbacks. Key features of our OPAT service were a multidisciplinary approach, criteria based patient selection, delivery of antibiotics and intravenous fluids via community pharmacy, provision of intravenous administration sets and trained nurses via external home care providers and use of validated tools and information leaflets for patients and home care nurses. The hospital pharmacist has a central role in informing patients and caregivers, delivery of hospital restricted antibiotics and as the contact person after discharge. After implementation of this structured OPAT service, more than twice as many patients could be discharged on OPAT at home compared with 2015.
Conclusion Based on the international literature and local experience, a structured OPAT programme was implemented at our hospital. Next steps are raising awareness and training health care providers, conducting patient satisfaction surveys and intensifying follow-up and audit of our OPAT service.
No conflict of interest
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