JAC Advance Access published online on April 12, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn152
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Original research |
An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service
1 Pharmacy Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK 2 Department of Practice and Policy, The School of Pharmacy, University of London, London WC1N 1AX, UK 3 Centre for Patient Safety and Service Quality, Imperial College Healthcare NHS Trust, London W6 8RF, UK 4 Department of Pharmacy, School of Biomedical and Health Sciences, King’s College London, London SE1 9NH, UK
Received 29 October 2007; returned 7 March 2008; revised 31 December 2007; accepted 12 March 2008
* Corresponding author. Tel: +44-208-846-1704; Fax: +44-208-846-1342; E-mail: mark.gilchrist{at}imperial.nhs.uk
Objectives: Administering parenteral antibiotics outside the confines of a ward setting is becoming an attractive way of treating infections in the UK. However, as well as having many advantages, an outpatient parenteral antibiotic therapy (OPAT) service potentially introduces new risks to staff and patients involved. In the United States, healthcare organizations are now prospectively analysing processes to try and prevent errors occurring using the Healthcare Failure Mode Effect Analysis (HFMEATM) tool. The objectives of this study were to map out and agree the OPAT process and sub-processes and to identify potential OPAT system failures using steps 1–3 of the HFMEATM tool, so that the resulting OPAT map can be used to design an OPAT service where risk is minimized.
Methods: The study was undertaken using a consensus development panel to which the HFMEATM process was applied. Key stakeholders in the local OPAT process were invited to join the HFMEATM team with the aim of describing and agreeing (defined as 100% participant agreement) an OPAT map, its sub-processes and potential OPAT system failures.
Results: The HFMEATM team identified 6 processes, 67 sub-processes and 217 possible failures over the course of four meetings. Key areas identified in the OPAT map concerned identifying and checking patient suitability for an OPAT service, involvement of a multidisciplinary team and robust communication channels.
Conclusions: An OPAT map was developed, which may serve as a practical model for other organizations setting up a similar service.
Key Words: antibiotic stewardship , antimicrobials , risk management
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