Outpatient parenteral antibiotic therapy using a patient or carer specific administration model: A review at the Princess Alexandra Hospital, Brisbane Queensland

Abstract

Background: Outpatient parenteral antibiotic therapy (OPAT) is an established model of care used to treat a variety of infections. The Alternate Site Infusion Service (ASIS) has provided OPAT to five hospitals in southern Brisbane, Queensland using a predominately patient - or carer- administration model since 1998. In this model of care, the patient or carer is trained to administer the antibiotics by using aseptic technique, thereby markedly reducing the needs for home visits by nursing staff. Training takes place on the day before discharge and usually required 1-2 hours of nursing time at the bedside. A visit to the home is scheduled on the day of discharge and whenever required afterwards. Methods & Materials: Patients treated by ASIS from 1/1/2011 to 31/121/2011 were included. Patient demographics, diagnosis, microbiology, antimicrobial therapy, duration, outcome and complications were sourced from a prospectively collected database and from patients’ medical records. Results: In 2011, there were 150 episodes of care in 144 patients with 3,520 days of OPAT. The median duration was 22 days (range 4-106). The most frequently treated organism was Staphylococcus aureus. The most commonly prescribed antibiotic was flucloxacillin. Patients with 2 or more co-morbidities had increased risk of failure (OR 2.15; 95% CI,1.28:3.65, p=0.004). The number of home visits made by nursing staff over 1 year was 466; much lower than the estimated 3,300 if a nursing administration model of OPAT was used. The cost of OPAT per patient excluding drug administration and home visits was approximately $150/day; significantly lower than the cost of an inpatient bed estimated to be $500-800/day. Conclusion: OPAT using a patient or carer administration model is an effective and safe option for the management of selected patients with infections requiring intravenous antibiotics.