Operational SOP for RHC OPAT – interim plan

The AMS team do twice weekly antimicrobial stewardship (AMS) rounds, on Monday and Thursday afternoons. Review the prescriptions for patients on IV antibiotics for over 48 hours on all wards, excluding on ward 2A and PICU.

At other times clinical teams can refer to the AMS team (84669) Monday to Friday, 9.00 – 17.00, out of hours the on-call Consultant Paediatric Infectious Diseases (via switchboard).

Patients suitable for OPAT are identified (considering clinical, social & caregiver criteria).

An OPAT treatment plan is developed with the AMS and responsible clinical team (IV antibiotic, dose, route of administration, planned IV antibiotic duration with pre-determined stop date).

If the planned duration of IV antibiotics is over 7 days, the responsible clinical team refers to anaesthetic colleagues (Dr Phil Bolton & Dr Danni Seddon) to arrange placement of a definitive line.

The responsible clinical or AMS team discusses OPAT with the patient/parent/carer, provides the patient information leaflet.

If OPAT is agreed, the responsible clinical team completes the Trakcare referral ‘OPAT referral – paediatrics’. Reviews monitoring requirements (as a minimum all patients require twice-weekly medical review and weekly FBC, UE, LFT, CRP) and arranges monitoring (including pre-ordering blood tests).

When the patient is discharged from the ward, the responsible team contacts ward 1C on Monday to Friday (84400) or CDU on Saturday and Sunday (84672/84670), to arrange admission to the Trakcare ‘RHC OPAT’ virtual ward and arrange appointments for OPAT.

The responsible clinical team completes the patient hand-held OPAT plan, ensuring patients/parents/carers know where and when to attend for the first appointment for OPAT, have contact details for the responsible team and know how to access care if they encounter OPAT-related problems at home. Completes the patient/carer declaration.

Admission to the Trakcare ‘RHC OPAT’ virtual ward will automatically generate a HEPMA encounter. The responsible clinical team should then prescribe the OPAT IV antibiotics before the patient leaves the hospital.

The responsible clinical team completes the IDL, to inform the GP of admission to OPAT. Adds the patient to their handover as on ‘OPAT’.

Whilst on OPAT clinical responsibility remains with the referring clinical team. The team should review during and at the end of OPAT treatment (as per pathway) and arrange follow-up if required.

The AMS team will facilitate entry of patients into the pathway and admission to the Trakcare ‘RHC OPAT’ virtual ward. Will do a weekly virtual review of all patients on the virtual ward, review the treatment plan, monitoring results, and follow-up arrangements, will document virtual reviews on Clinical Portal. At the end of treatment will complete an IDL. On discharge from the virtual ward will outcome patients. Will prospectively collect outcome monitoring data.