Patient and Caregiver Provision of Outpatient Parenteral Antimicrobial Therapy (OPAT): A Patient-Centered Quality Improvement Initiative

为患者和护理人员提供门诊肠外抗菌治疗 (OPAT)：一项以患者为中心的质量改进计划

• 批准号: 9900747
• 负责人: Sara Condron Keller
• 金额: $ 14.27万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9900747
• 关键词: Patient; Caregiver; Provision; Outpatient; Parenteral

With increasing demands for cost reductions, the US healthcare system has moved many complicated medical technologies from the hospital to the home. However, to successfully use these technologies, patients and their caregivers must perform complicated medical tasks that typically would be the role of skilled inpatient nurses. One medical technology, outpatient parenteral antimicrobial therapy (OPAT), allows patients needing long-term parenteral antimicrobials to complete these regimens after discharge via venous catheters. These patients and their caregivers perform infusions and catheter care at least daily for several weeks. They are at risk of significant complications such as catheter complications, adverse drug events, and relapse of the infection. It is unclear which patient-level risk factors may affect outcomes, how patients and caregivers actually perform OPAT-related tasks, or how to improve patient/caregiver performance of OPAT-related tasks. This proposal will identify risk factors for OPAT complications and determine which processes of OPAT administration are more likely to fail. The project will engage patients, caregivers, and home health providers as key stakeholders in understanding the risk factors for poorer outcomes and how to modify these risks to successfully complete OPAT tasks, and in developing and piloting an OPAT intervention. Specific Aim 1: To create a risk score to predict the development of OPAT complications through a prospective cohort of OPAT patients discharged from two academic medical centers. A prospective cohort of OPAT patients will be used to create a risk derivation and validation cohort to develop a risk score for OPAT complications that can be used at hospital discharge to identify patients who may need additional assistance with OPAT. Specific Aim 2: To complete a proactive risk assessment that (1) identifies ways in which OPAT patients might be harmed, and (2) informs an intervention which improves safety among patients receiving OPAT. Semi-structured interviews of patients and home observations of patients and caregivers performing OPAT tasks will be used to identify hazards in OPAT performance. This information, and the risk score from Aim 1, will be presented to groups of patients and caregivers, home health nurses, and home infusion pharmacists to develop and prioritize interventions to improve the quality of OPAT care. This intervention will be piloted among a small group of home health nurses and patients to assess its feasibility and acceptability. The overall goal of this proposal is to prepare Dr. Keller for a career as an independent investigator in patient safety by using human factors engineering and stakeholder engagement to improve the quality and safety of OPAT.

随着降低成本的需求不断增加，美国的医疗保健系统已经将许多复杂的 从医院到家庭的医疗技术。然而，为了成功地使用这些技术， 病人和他们的护理人员必须执行复杂的医疗任务， 熟练的住院护士。一项医疗技术，门诊非肠道抗菌治疗（OPAT）， 允许需要长期胃肠外抗菌剂的患者在出院后完成这些方案 通过静脉导管。这些患者及其护理人员至少进行输液和导管护理， 每天几个星期。他们有严重并发症的风险，如导管并发症， 不良药物事件和感染复发。目前尚不清楚哪些患者水平的风险因素可能会影响 结果，患者和护理人员如何实际执行OPAT相关任务，或如何改善 患者/护理人员执行OPAT相关任务。该提案将确定OPAT的风险因素 并发症，并确定哪些过程的OPAT管理更有可能失败。的 该项目将使患者、护理人员和家庭保健提供者作为主要利益相关者参与， 了解不良结局的风险因素，以及如何成功地改变这些风险 完成OPAT任务，并制定和试行OPAT干预措施。具体目标1：创建 通过前瞻性队列研究预测OPAT并发症发生的风险评分， OPAT患者从两个学术医疗中心出院。OPAT前瞻性队列研究 患者将用于创建风险推导和验证队列，以制定OPAT的风险评分 出院时可用于识别可能需要额外治疗的患者的并发症 OPAT的帮助。具体目标2：完成主动风险评估，以（1）确定 OPAT患者可能受到伤害的方式，以及（2）告知改善的干预措施 接受OPAT的患者的安全性。患者和家庭的半结构化访谈 对执行OPAT任务的患者和护理人员的观察将用于识别 OPAT性能。这些信息以及目标1中的风险评分将提供给 患者和护理人员、家庭保健护士和家庭输液药剂师， 采取干预措施，提高OPAT护理质量。这项干预措施将在一个小团体中试行 的家庭保健护士和病人，以评估其可行性和可接受性。总的目标是 建议是准备凯勒博士的职业生涯作为一个独立的调查员在病人安全使用 人因工程和利益相关者的参与，以提高OPAT的质量和安全性。

项目成果

Which Patients Discharged to Home-Based Outpatient Parenteral Antimicrobial Therapy Are at High Risk of Adverse Outcomes?

• DOI: 10.1093/ofid/ofaa178
• 发表时间: 2020-06-01
• 期刊: OPEN FORUM INFECTIOUS DISEASES
• 影响因子: 4.2
• 作者: Keller, Sara C.;Wang, Nae-Yuh;Cosgrove, Sara E.
• 通讯作者: Cosgrove, Sara E.

Assessing burden of central line-associated bloodstream infections present on hospital admission.

评估入院时中心静脉导管相关血流感染的负担。

• DOI: 10.1016/j.ajic.2019.08.010
• 发表时间: 2020
• 期刊: American journal of infection control
• 影响因子: 4.9
• 作者: Leeman,Hannah;Cosgrove,SaraE;Williams,Deborah;Keller,SaraC
• 通讯作者: Keller,SaraC

Implementing a Toolkit to Improve the Education of Patients on Home-Based Outpatient Parenteral Antimicrobial Therapy (OPAT).

实施工具包以改善对患者的家庭门诊肠外抗菌治疗 (OPAT) 教育。

• DOI: 10.1016/j.jcjq.2022.05.008
• 发表时间: 2022
• 期刊: Joint Commission journal on quality and patient safety
• 影响因子: 2.3
• 作者: Keller,SaraC;Salinas,Alejandra;Gurses,AyseP;Levering,Mayo;Hohl,Dawn;Hirsch,David;Grimes,Michael;Ziemba,Kaylin;Cosgrove,SaraE
• 通讯作者: Cosgrove,SaraE