Part II: Outpatient Parenteral Antimicrobial Therapy

The primary goals of the OPAT service are to allow patients to complete antimicrobial treatment safely, comfortably and effectively in the outpatient setting and to avoid inpatient-related inconveniences and complications. [130–132]
An OPAT team is a multidisciplinary team consisting of infectious disease (ID) specialists, nurses and pharmacists. Timely communication between nurses, pharmacists, ID specialists and patients is essential in OPAT program. [130–132]

Table 2.1: Roles of OPAT Team Members

Team Members	Roles
ID specialist	Establish clinical diagnosis Determine whether patient is fit for outpatient care Be responsible for clinical care decisions Determine whether OPAT is appropriate Select appropriate antimicrobials Order appropriate tests for monitoring Assess patient at follow-up visits Monitor for potential antimicrobial associated adverse events
ID Nurse	Assess patient and caregiver suitability for parenteral therapy at ambulatory setting Play a lead role in recommendation for the type of vascular access device and in the care of the infusion device Provide education on the care of vascular access device and catheter infusion site, information for common problems, side effects, precautions Assess patient at follow-up visits Monitor for antimicrobial adverse events and catheter related problems Coordinate patient care Ensure rapid and reliable communications about problems and for monitoring of therapy in place between members of OPAT team
ID/Clinical Pharmacist	Recommend on PK/PD and stability of antimicrobials Provide advice on potential drug-drug interactions
Patient and caregiver	Any person (include family members, friends, or caregivers like elderly home aides) with the ability and willingness to assist the transfer of patients between their home and the hospital Involved in planning of the OPAT service and follow-up arrangement

Table 2.2: Main Bundle Components of OPAT

Main Bundle Components	Key Aspects of Component
Patient Identification/ Selection	•	Afebrile and stable vital signs
	•	Infection should be reasonably stabilised and non-progressive
	•	Not likely to abuse a vascular access system (e.g. injection drug user)
	•	Fully aware of benefits and risks
	•	Appropriate and adequate social support
	•	Capable and responsible for the infusion, care of the vascular access device, and the care of the catheter infusion site, and be able to recognise and report new problems such as fever and rash.
	•	Willingness to comply with follow-up plan
ID Consultation	•	Establishment of clinical diagnosis
ID Consultation	•	Selection of appropriate antimicrobials
Selection of Antimicrobials	Factors:
	•	the definite or probable infecting organism
	•	the pharmacodynamics and pharmacokinetic properties of antimicrobials and drug stability
	•	patient’s medical condition
Patient/family education	•	Vascular access education/sterile technique/teach-back method
	•	Emergency contact numbers for patients
	•	Side effects of medication
	•	Potential Complications
Care transition	•	Clear communication between inpatient and outpatient services
	•	ID/OPAT plan documented in discharge summary
	•	Laboratory tests ordered as part of discharge plan
Outpatient monitoring	•	Clinical response
	•	Microbiological, laboratory and radiological monitoring
	•	Addressing lab abnormalities
	•	Vascular access care, and removal at the end of therapy
	•	Medications adjustment as needed (choice, dose, duration)
	•	Adverse effects of antimicrobial
	•	Change in management if needed
	•	Good communication between members of OPAT team
Written policies and protocols	•	Outline of responsibilities of OPAT team members
	•	Outline of communications between patient and OPAT team
	•	Outline of service arrangement during severe weather
	•	Patient selection criteria
	•	Patient education materials
OPAT program outcomes measures	•	Patient satisfaction
	•	Readmission rates
	•	Clinical outcomes including any complications of disease and adverse effects of antimicrobials
	•	Complications of vascular access
	•	Program improvements