It's Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks

Abstract

Outpatient parenteral antimicrobial therapy (OPAT) requires patients and caregivers to infuse antimicrobials through venous catheters (VCs) in the home. The objective of this study was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of OPAT. The authors performed 40 semi-structured patient interviews and 20 observations of patients and caregivers performing OPAT-related tasks. Six overall goals were identified: (1) understanding and developing skills in OPAT, (2) receiving supplies, (3) medication administration and VC maintenance, (4) preventing VC harm while performing activities of daily living, (5) managing when hazards lead to failures, and (6) monitoring status. The authors suggest that patients and caregivers use teach-back, take formal OPAT classes, receive visual and verbal instructions, use cognitive aids, learn how to troubleshoot, and receive clear instructions to address areas of uncertainty. Addressing these goals is essential to ensuring the safety of and positive experiences for our patients.

Keywords: home care; home infusion therapy; human factors engineering; outpatient parenteral antimicrobial therapy; task analysis.

Figure 1.

Examples of patient and informal caregiver performance of tasks. (A) A patient and her informal caregiver took notes on an instruction sheet about how to set up their infusion pump, writing additional subtasks they were told also were necessary but were not written on the instruction sheet. (B) Patient receiving both total parenteral nutrition (TPN) and ertapenem uses the saline-administer-saline-heparin (SASH) system to start infusing his ertapenem. This laminated placemat allowed the patient and his home health nurse to take additional notes to tailor the task to his particular situation as well as reminders to scrub the venous catheter tip for 15 s with alcohol preparation pads prior to each subtask. (C) A patient’s informal caregiver injects a reconstituted antibiotic (ceftaroline) into a mini-bag of saline prior to initiation of infusion using a needle. The week prior, the patient informed the study team that this subtask had resulted in the caregiver sustaining a needlestick injury.