Using an interactive, in-person barrier identification and mitigation (BIM) tool can successfully identify barriers as well as potential solutions for safe home-based outpatient parenteral antimicrobial therapy (OPAT) care, according to study results published in Open Forum Infectious Diseases.

Between May and July 2019, researchers convened 4 groups comprising patients, caregivers, and healthcare providers to identify barriers to the safe provision of home-based OPAT through an in-person group BIM process. Any patient who had received home-based OPAT after discharge from Johns Hopkins Hospital, or the caregiver of the patient, were eligible to be included in the study. Eligible healthcare workers included those who were involved in the referral or care of patients on home-based OPAT including home care coordinators, home infusion pharmacists, home infusion nurses, and home infusion administrators. Each group was led by an infectious diseases physician with expertise in OPAT and contained 4 to 8 participants, and each session lasted approximately 2 hours.

The 4 groups included 24 participants, of which 7 were patients and 3 were caregivers. Overall, 75% of the participants were women and 70% were white. Two groups included patients who had received home-based OPAT and their caregivers (n=4 and n=6), 1 included home care coordinators (n=6), and 1 enrolled home infusion staff members (n=8).

Four major barriers were identified: a lack of streamlined communication between healthcare providers, hastily provided instructions at the time of hospital discharge, practical challenges with protecting intravenous catheters from moisture, and not providing appropriate instructions to all relevant stakeholders.


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Suggestions to improve communication between healthcare providers included expanding access to medical records for home infusion agencies in different health systems. scheduling follow-up appointments prior to discharge, and having patients assist with transmitting information by providing documentation to members of the healthcare team.

Healthcare providers are advised to identify patients requiring OPAT early during their hospital stay and develop a discharge plan as soon as possible. Instructions created based on a patient’s education or abilities should be provided in written and visual form, including handouts and videos.

Maintaining a dry intravenous line dressing while bathing was identified as one of the most significant barriers to safe OPAT care.  Suggested strategies to keep dressings dry and intact include placing an adherent cling wrap and taping clean plastic bags over dressings, providing supplies to patients in the hospital upon discharge, evaluating dressings more frequently, and using a detachable shower head when bathing to direct the flow of water away from the dressing.

“Our qualitative study was hypothesis-generating, and future studies should be performed to see if the proposed strategies may be effective in preventing OPAT complications,” concluded the researchers.

Reference

Keller SC, Tamma P, Salinas A, Williams D, Cosgrove SE, Gurses AP. Engaging patients and caregivers in a transdisciplinary effort to improve outpatient parenteral antimicrobial therapy [published online May 21, 2020]. Open Forum Infect Dis. doi:10.1093/ofid/ofaa188