In:
Archives of Disease in Childhood, BMJ, Vol. 103, No. 2 ( 2018-02), p. 165-169
Abstract:
Despite the many benefits of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT) programmes, there are risks associated with delivering inpatient-level care outside of hospital. There is a paucity of evidence defining how best to mitigate these risks. We examined the impact of introducing a dedicated medical team to OPAT, to define the role of increased medical oversight in improving patient outcomes in this cohort. Design A prospective 24-month pre–post observational cohort study. Setting The Hospital in the Home (HiTH) programme at Princess Margaret Hospital (PMH) for Children, Western Australia. Patients All OPAT admissions to HiTH, excluding haematology/oncology patients. Interventions PMH introduced a dedicated OPAT medical support team in July 2015 to improve adherence to best-practice guidelines for patient monitoring and review. Main outcome measures Duration of OPAT, adherence to monitoring guidelines, drug-related and line-related adverse events and readmission to hospital. Results There were a total of 502 OPAT episodes over 24 months, with 407 episodes included in analyses. Following the introduction of the OPAT medical team, adherence to monitoring guidelines improved (OR 4.90, 95% CI 2.48 to 9.66); significantly fewer patients required readmission to hospital (OR 0.45, 95% CI 0.24 to 0.86) and there was a significant reduction in the proportion of patients receiving prolonged (≥7 days) OPAT (OR 0.67, 95% CI 0.45 to 0.99). Conclusion The introduction of a formal medical team to HiTH demonstrated a positive clinical impact on OPAT patients’ outcomes. These findings support the ongoing utility of medical governance in a nurse-led HiTH service.
Type of Medium:
Online Resource
ISSN:
0003-9888
,
1468-2044
DOI:
10.1136/archdischild-2017-313071
Language:
English
Publisher:
BMJ
Publication Date:
2018
detail.hit.zdb_id:
1481191-1
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