Outpatient Parenteral Antibiotic Therapy (OPAT) Inefficiencies and Production Process

Health care unit should be HOME ANTIBIOTIC THERAPY or Outpatient Parenteral Antibiotic Therapy (OPAT) – a service offered by hospitals in the community. Patients are discharged home and nurses go to give antibiotics in their homes. What inefficiencies might arise in this process and how can one address these inefficiencies? Analyse also what factors affect the production process of this healthcare unit.

 

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Outpatient Parenteral Antibiotic Therapy (OPAT) Inefficiencies and Production Process

Outpatient parenteral antimicrobial therapy (OPAT) is one of the healthcare units that has proven effective in providing cost-effectiveness in treating patients. The OPAT has allowed patients who have shown sufficient recovery in a medical facility to be discharged and get their intravenous (IV) antibiotics injections at home. The OPAT involves visiting the patient’s home where “The nurse usually returns once weekly for dressing changes, draw labs, and monitor the patient for adverse events” (John Hopkins Medicine). Therefore, OPAT is a service offered by a hospital to the community with the idea of reducing the costs of being admitted to the hospital and other factors such as decongestions. OPAT suffers from numerous inefficiencies such as mobility limitations, inability to provide dosing twice a day, failed treatment, a high rate of rehospitalization, and breakdown in communication which all affect the production process of OPAT due to logistical issues, lack of support from family and lateness or absenteeism of nurses.

OPAT Inefficiencies and Possible Solutions

Mobility limitations are one of the major inefficiencies that affect the OPAT process because it becomes difficult for a patient with a chronic illness to move from one point to another. OPAT is meant to bring comfort and convenience to patients, especially those with chronic illnesses or the elderly who might find visiting daily a physical medical facility tiresome. Berrevoets et al. (2018) claim, “For people without mobility limitations due to their underlying illness, OPAT negatively impacted their freedom.” The findings prove mobility challenges are one of the main inefficiencies affecting OPAT success, especially when the patients are without any underlying health issues because it takes away their freedom to interact with others as they lay down all day in the house. Therefore, OPAT negatively affects patients who would otherwise have enjoyed movement to and from the medical facility. One of the best ways that the inefficiency of mobility limitations can be addressed is by allowing patients that can access the medical facility to get their antibiotic injection without having to place under the OPAT program. Despite OPAT being effective for patients with difficulties in movement, it can be stressful for the patients without any physical challenges because it would limit them in the house, which takes away their freedom of movement.

The inability of nurses to provide intravenous antibiotics injections more than once a day is an inefficiency that affects the effectiveness of OPAT. The proximity or location of the patients can prove challenging for OPAT nurses to visit them daily for an injection. Those prescribed more than two injections a day will be forced to attend a physical or medical facility or miss some of the injections. According to Laupland and Valiquette (2013), “…if typical business hours are observed, one potential drawback is the inability to provide dosing of drugs more than once per day.” The inability to provide intravenous antibiotics injections emerges as a problematic inefficiency for the OPAT program because it means a patient will have to miss some of the injections, making it challenging to avoid readmission to a hospital. The OPAT inefficiencies in ensuring that patients get the recommended doses make the whole program hard to implement everywhere, especially in areas that are not easily accessible. Therefore, due to working hours, nurses might find it more challenging to ensure consistency in administering intravenous antibiotics injection for patients at home than if they were admitted to the hospital. According to Buehrle et al. (2017), “Sixty-one percent of intravenous drug users (IVDUs) who received outpatient parenteral antibiotic therapy (OPAT) failed treatment.”  The statement shows the inefficiencies of the OPAT because when it becomes difficult to give more than one injection a day translates to patients failing to recover from illnesses. The best solution to this inefficiency is ensuring that patients who have been prescribed more than two injections per day are admitted to the hospital.

The number of patients under the OPAT is at a high level of being re-admitted or rehospitalized due to failed treatment, making it ineffective. The inefficiency of nurses in administering intravenous antibiotic injections makes it difficult for patients to recover fully. A study conducted by Ng et al. (2021) found that “…patients utilizing OPAT in this study, and we observed that most of our rehospitalized patients were initially discharged home.” Therefore, the OPAT proves inefficient in ensuring patients’ positive outcomes and full recovery, leading to rehospitalization. The re-admitted patients lose more resources and time, which was initially meant to be avoided with the OPAT program. The rehospitalization of patients under the OPAT program proves that it is more inefficient than being admitted to the hospital. The safety of OPAT is therefore questionable because it has failed to achieve its primary purpose, providing safe and efficient intravenous injection in the comfort of their homes. The best solution to rehospitalization is ensuring a proper follow-up on patient recovery. Furthermore, patients who live in areas that place them in a position of not getting their daily injections should be admitted to the hospital.

Communication is a major barrier for OPAT, especially when different nurses have to provide injections or monitor more than one patient. Lack of effective communication between nurses serving on different shifts is a major inefficiency facing OPAT, as administering intravenous antibiotic injections may require daily attendance. Twiddy (2018) claims, “A perceived breakdown in communication between OPAT staff could erode patient confidence and fuel anxiety about not being in hospital.” Therefore, the lack of proper communication between nurses can devastate the patient, especially when they have to answer daily inquiries about their medical history from a different nurse. The lack of information from one nurse to another might affect the patient’s confidence in their competency, leading to anxiety because they do not know if they are recovering. One of the solutions that can be utilized in dealing with communication inefficiencies between nurses is ensuring that there is a report with all the information about the patient medical history, treatments, and recovery journey. The report will help build patients’ confidence and reduce anxiety because even if different nurses come to give the antibiotic injection, they are familiar with the treatment details, such as the remaining doses.

Factors affecting the production process

The logistical problem is a significant factor that affects the production process of OPAT due to the difficulties in administering and monitoring patients living in adverse environments that make transport difficult. OPAT was a program that was initially meant to provide convenience to patients, especially those with few resources to be administered in a physical hospital. According to Mitchell et al. (2017), “Few studies considered practitioner acceptability, but those that did found some concerns related to the logistics involved in providing an OPAT service, including cost and who would assume clinical responsibility for patients.” The OPAT has been marred with difficulties in the production process with logistical problems making it hard for nurses to access some patients as required. The cost of OPAT has proven difficult for many medical organizations, especially in attending to patients living in adverse environments. The logistical problem that emerges from the OPAT is who will cover the costs, especially the transportation, based that most patients accept it because it is cost-effective. Administering and monitoring patients is difficult for nurses when they are not provided with the necessary resources to reach all patients, such as transport.

The lack of family support in helping make the OPAT a success negatively affects its production process. The family plays a significant part in recovering a patient receiving intravenous antibiotics injections because, at times, they may be required to administer the injection on behalf of the hospital. According to Chapman (2013), “home-based care must be suitable from a social perspective—for example, an acceptable home environment, access to a telephone, adequate transport, and support from family or careers” (p.28). These resources, such as transport, telephone, or family support, are essential in making the production process successful. Therefore, when family support or transport is missing, it constrains the production process of OPAT, which affects its impact on patients. Family support is crucial because they are a significant contributor to ensuring that all the prescriptions given to their kin are administered. Therefore, when family members acting as caregivers refuse to fully engage in training on administering intravenous antibiotics injections, it negatively affects the OPAT production process.

The problem of lateness and absenteeism among nurses is affecting the production process of OPAT because of increased missed injections leading to rehospitalization. Nurses are workers who sometimes are affected by numerous personal issues that might prevent them from coming to work or visiting patients under the OPAT program. According to SHTG (2021), a study revealed that “…when nurses were late or failed to attend, this was a significant source of worry and frustration” (p.36). The lateness and absenteeism affect the production process because patients feel worried when they fail to get their intravenous antibiotics injections from time to time. The absenteeism affects the production process of the OPAT because most patients tend to intravenously abuse the drugs and devices, making it difficult to achieve its intended purpose (Bugeja, 2020, p. 117). The findings prove that the lack of consistency in administering the intravenous antibiotic injection due to nurses’ absenteeism significantly affects the production process of OPAT. Nurses need to attend to home-based patients as they would in a hospital to ensure that antibiotic doses are followed for quick recovery and avoidance of rehospitalization.

OPAT was initially started to ensure home-based patients get the safest and most convenient medical care. However, due to different inefficiencies such as mobility limitations, inability to provide dosing twice a day, failed treatment, high rehospitalization rate, and communication breakdown, it became difficult to implement these goals. The inefficiencies made it impossible to run the OPAT program efficiently for nurses due to the unforeseen demands it required leading to a negative impact on its production process. Therefore, the best solution is to ensure that OPAT is structured in a manner that provides easy accessibility of patients by nurses to avoid them feeling distressed and anxious when numerous uninformed nurses attend them or not getting their intravenous antibiotic injections on time or missing altogether.

 

 

References

Berrevoets, M. A., Oerlemans, A. J., Tromp, M., Kullberg, B. J., Ten Oever, J., Schouten, J. A., & Hulscher, M. E. (2018). Quality of outpatient parenteral antimicrobial therapy (OPAT) care from the patient’s perspective: a qualitative study. BMJ open8(11), e024564.

Buehrle, D. J., Shields, R. K., Shah, N., Shoff, C., & Sheridan, K. (2017, July). Risk factors associated with outpatient parenteral antibiotic therapy program failure among intravenous drug users. In Open forum infectious diseases (Vol. 4, No. 3). Oxford University Press.

BUGEJA, S.J. 2020. Applying a human factors approach to evaluating a novel outpatient parenteral antimicrobial therapy service in Malta. Robert Gordon University, Ph.D. thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-1357920

Chapman, A. L. (2013). Outpatient parenteral antimicrobial therapy. BMJ346.

John Hopkins Medicine. (2021, April 8). Outpatient parenteral antibiotic therapy (OPAT) | Division of infectious diseases. Johns Hopkins Medicine, based in Baltimore, Maryland. https://www.hopkinsmedicine.org/infectious-diseases/patient-care/outpatient-parenteral-antibiotic-therapy-opat.html

Laupland, K. B., & Valiquette, L. (2013). Outpatient parenteral antimicrobial therapy. Canadian Journal of Infectious Diseases and Medical Microbiology24(1), 9-11.

Mitchell, E. D., Murray, C. C., Meads, D., Minton, J., Wright, J., & Twiddy, M. (2017). Clinical and cost-effectiveness, safety and acceptability of community intravenous antibiotic service models: CIVAS systematic review. BMJ open7(4), e013560.

Ng, N., Bailey, P., Pryor, R., Fung, L., Veals, C., Sabouri, K., & Reznicek, J. (2021). Experiences in outpatient parenteral antimicrobial therapy (OPAT): Barriers and challenges from the front lines. Antimicrobial Stewardship & Healthcare Epidemiology, 1(1), E42. doi:10.1017/ash.2021.213

Scottish Health Technologies Group. (2021). Outpatient parenteral antimicrobial therapy (OPAT). https://shtg.scot/media/1745/outpatient-parenteral-antibiotic-treatment-opat-shtg-recommendation-01-21.pdf

Twiddy, M., Murray, C. J. C., Mason, S. J., Meads, D., Wright, J. M., Mitchell, E. D., & Minton, J. (2018). A qualitative study of patients’ feedback about Outpatient Parenteral Antimicrobial Therapy (OPAT) services in Northern England: implications for service improvement. BMJ open8(1), e019099.

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