Keynote Lecture

OPAT:The Current Picture, the Vision and the Patient Experience - Dilip Nathwani, Dundee

Presentation Overview

Acute and chronic infections present the NHS with a considerable healthcare burden. Their management is becoming increasingly complex with significant impact on healthcare resources. Clinical teams need a number of alternatives or options to manage these infections in the hospital and ambulatory setting. Outpatient and parenteral antimicrobial therapy (OPAT) fulfils many of the essential criteria (e.g choice, locally driven, high quality, patient centred and integrated) outlined in the NHS reforms that plan to improve patient care and access and would also address the recent concerns about NHS waste and inefficiency. The objectives of this presentation are to set the scene for subsequent presentation by communicating to participants the value, safety of OPAT combined with a vision of how innovative services, such as OPAT, in the UK should evolve in the future. The emphasis of further development should be focused around investment in a high quality service valued by clinicians, patients and carer’s but also highlighting opportunities to address inefficiencies in health care. OPAT represent a truly multi-professional service and offers a potential opportunity to evaluate the impact of such services on topical outcomes such as reduced healthcare acquired infections, potential to reduce C.difficile and cost-effectiveness from a societal and primary care perspective.

Plenary One: Setting the Standards

Development of a Patient Focussed and Safe Service - Ann Chapman, Sheffield

Presentation Overview

Outpatient Parenteral Antibiotic Therapy (OPAT) offers a rare opportunity to improve patient care and choice while at the same time reducing costs. However, it is important to develop a service that is patient-focused and safe, in order to minimise the risks associated with treating patients with severe infections out of hospital. In this talk, we will consider safety issues relating to patient selection, service design, clinical pathways and documentation, and lines of communication, as well as discussing patients’ views on OPAT.

Products (Agents & Devices) – Types, Routes, Transport, Storage, Administration
- Brendan Healy, Cardiff & Victoria Parker, Sheffield

Presentation Overview

The idea that IV antibiotics could be safely administered at home, by patients themselves, is one that some years ago may have cause gasps of horror amongst the medical fraternity. Modern equipment and newer, once daily antibiotics have led to this idea being possible, with the development of OPAT services. This presentation will briefly discuss the devices, equipment, training and support that enable such a service to be offered from the Infectious Diseases Unit in Sheffield. Commonly used equipment includes PICC lines, Alaris infusion pumps and giving sets, along with drug paraphernalia such as dry powder vials and ready mixed infusions. Combined with expert training and supervision, these items help to form the OPAT “Tools of the Trade”. Dr Healy will give a brief overview of the pharmacokinetics of antibiotics and the relevance of pharmacokinetics in choosing appropriate antibiotic therapy for OPAT.

Models of Medical and Nursing Management and Care: Who Do You Really Need & Why?
- Carol Low, London & Albert Lessing, London

Presentation Overview

Modern medical healthcare offers antiinfective treatment modalities not previously available to the patient with significant bacterial infection. Similarly healthcare has contributed to new infections attributed to devices and deep-seated infection. A clear diagnosis by an consultant adept in infectious processes need to be made and an appropriate in or out of antiinfective treatment agreed by a multidisciplinary team based on evidence, clinical and cost effectiveness, and safety, Patient safety is paramount. Studies in the US has shown that where infectious disease physicians take the lead quality care is delivered – however such lead is only available in half of cases, many non-experts contributing to substandard care models. Infectious processes should be stratified into a smaller case-load of more intensive and longer duration treatment plans in contrast to a larger and potentially poorly selected superficial infections. The care setting will depend on locality and expertise. Delivery includes a dedicated “outpatient” setting (e.g. “Scottish-model) or “home” setting (eg. “English-model) where the antiinfective is administered by a specialist nurse or self-administered per peripheral inserted central catheter (PICC).

Outcome Evaluation and Review - Bridget Atkins, Oxford

Presentation Overview

Outpatient parenteral antimicrobial therapy is a popular concept amongst healthcare professions, managers and patients as it potentially reduces the number of hospital bed days and allows care of the patient in the setting they are most familiar and comfortable with – their own home. They may also be extra benefits in terms of reduction in the risk of acquisition of nosocomial infections such as MRSA and Clostridium difficile associated diarrhoea. The process should however not be regarded as risk free. There is a significant risk of developing acute or sub-acute and sometimes life threatening complications (e.g. anaphylaxis, other drug toxicity, line infection) or failure to resolve the original underlying infection. These may require urgent or semi-urgent re-admission to a health care facility and further investigations and change of plan. A process need to be in place whereby all patients have 24 hour access to and have regular review by medical staff trained in infection issues, in addition to OPAT nurse specialists and pharmacists. A registry of adverse effects and treatment outcomes is recommended plus regular feedback to all involved. More research is needed to establish ideal durations and routes of antibiotic administration.

Plenary Two: Developing an Appropriate Business Case

Clinical and Economic Drivers for OPAT Success - Paul Chadwick, Salford

Developing and Presenting Your Business Model - Brian Ward

Presentation Overview

Since the reforms of the NHS back in 1990 the NHS has moved to a more business-like footing, while staying mindful to keep the interests of patients’ upper most. We now have very sophisticated systems in place throughout the NHS for measuring value for money investments in healthcare service delivery. The recent economic downturn is having an impact on the NHS and is predicted to be a fact of life for us in the U.K. for years to come. Funding for services is likely to be even more closely scrutinised in future. OPAT represents an important opportunity to enhance patient care in appropriate circumstance. The establishment by BSAC with the BIS of standard methods of implementing OPAT services comes at a time when managers and clinicians are working together in many parts of the NHS to find safe and more efficient ways of delivering improved services to patients.

The objectives of my presentation are to describe:

The benefits of preparing a business plan for OPAT.
The role of the OPAT team in preparing the plan.
The benefits of fitting the aims for OPAT into the vision of your Trust.
What to include in the plan.
Ways of minimising rejection.
Some of the “immutable laws” of marketing as they are likely to apply to OPAT service delivery in any NHS hospital Trust or PCT.

Dwight D. Eisenhower said in 1944. “Plans are nothing; planning is everything”. Does this philosophy hold true when writing a business plan for OPAT? Perhaps.

Plenary three: Implementing and evaluating an OPAT service

Not One Size FitsAall – Defining Your OPAT Requirement(s) - Graeme Jones, Southampton

Presentation Overview

Every healthcare provider has an individual case mix determined by local factors and so will have different requirements of an OPAT service. Individual OPAT services have developed differently to meet these local requirements and each model of service delivery has strengths and weaknesses. Adopting the appropriate service model will maximise the impact of the business case to develop your OPAT service.

Following this presentation you will be able to:

Identify patient groups suitable for OPAT in your practice
Appreciate the range of different service models to deliver safe OPAT care that you could employ
Review how different models of service delivery address the essential components of a safe OPAT care that you will need to consider

How Should We Evaluate OPAT and Governance of OPAT – What Are Our Markers For Success? - • Patient outcome • Patient satisfaction • Service Improvement • Fiscal and Economic Determinants
- Mark Gilchrist, London

Presentation Overview

In the ever changing world of the NHS, we all have a responsibility to strive for clinical excellence under the umbrella of clinical governance. Outpatient Parenteral Antimicrobial Therapy (OPAT) fits nicely into recent government and patient agenda’s into providing healthcare services, although difficulty sometimes comes in determining what the markers for success for such a service are? Is it clinical effectiveness, risk management, patient experiences, strategy, finance or something else? This short presentation will give suggestions as to how the multidisciplinary team (clinical + non clinical) can evaluate OPAT and what markers can be used to examine patient outcome, satisfaction, service development and economic determinants.

Overview of online survey results

Closing comments

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