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Nurse-Led OPAT (Outpatient Parenteral Antimicrobial Therapy) CareCoordination Program to Improve Outcomes in Adult Osteomyelitis Patients. Temitope Ajani, BSN, RN (DNP student - Radford University) Background: Outpatient parenteral antimicrobial therapy (OPAT) describes the administration of parenteral antimicrobials without hospitalization (Norris et al., 2019). There are numerous benefits as well as associated complications. (Bodycot, et al., 2021; Chapman et al., 2019; Huang, Ruhe, Lerner, & Fedorenko, 2018; Keller et al., 2018). Complications that are often encountered in OPAT include hospital readmissions, adverse drug reactions, or problems with central venous access devices, (Lai et al, 2012). Formal OPAT programs have been proposed to mitigate these risks, but there exists a paucity of evidence regarding the specific design of these programs (Mansour, et al., 2018; Norris et al., 2019). Nurse care coordination has been proposed to improve patient outcomes in OPAT (Huck et al., 2014; Jingping Xing, Goehring, & Mancuso, 2015; Marbach et al., 2018; Altfeld et al., 2013; Luu et al., 2019; Shrestha et al., 2018). Why research is needed: To evaluate the effectiveness of OPAT program design. Current State of Knowledge: Huck et al., (2014) found that unavailable laboratory test results were linked to a higher probability of unplanned readmission. Similarly, Marbach et al., (2018) recorded a higher incidence of 30-day readmissions in patients who did not receive post discharge care. A transitional care program reduced the rates of readmissions, and mortality (Altfeld et al., 2013), while another nursemanaged OPAT program recorded a significant reduction in readmissions (Mansour, Heslin, & Townsend, 2018). Research Question and Outcome Variables: Does a Nurse-led OPAT Care Coordination program decrease the rate of 30-day hospital readmission, incidence of adverse drug and central line events in adult osteomyelitis patients enrolled in a formal OPAT program compared with those who received only the traditional post discharge care? Research Objectives: To evaluate the impact of a nurse–led OPAT care coordination program; identify risk factors; and provide recommendations for improvement.
Methods: This is a retrospective, Quality Assurance/Quality Improvement (QA/QI) project. Study Design: The Intervention Group received the OPAT care coordination while the Control Group received only the traditional post discharge care. The groups received post discharge antimicrobial therapy from July 2018 to December 2019. Population, Inclusion, and Exclusion Criteria: Adult patients, 18 years old and above, with a diagnosis of osteomyelitis, discharged with a minimum of 2 weeks parenteral antimicrobial therapy to Carilion Clinic home health agencies.
