Who is needed for COPAT?
In an ideal situation, the core and essential members of a COPAT service are:
- A doctor (preferably with considerable infection expertise)
- An experienced nurse
- A pharmacist (preferably with considerable antibiotic expertise)
Only one of the team needs to be a prescriber, although a prescribing pharmacist or nurse makes running the service easier.
It may be possible to run such a service with only two out of the above three professionals, but one of the team must be a trained prescriber and able to make advanced clinical decisions in the context of complex infections.
In fact, in Hull, until now we have mainly run the service without pharmacist input to our weekly MDT meetings, however, in such a situation it is vital that other members of the team have considerable pharmacological knowledge and experience and that liaison with pharmacy remains possible.
A single-handed service is not recommended from a clinical governance perspective, although it is acknowledged that in low- or middle-income countries the resources for such a service may not be available or that single-handed practice may be unavoidable. Arguably, the most important collective skills of the team are not knowledge or experience, however, but:
Understanding of the team’s limitations
Understanding of how to seek advice when needed
The ability to work and communicate well with each other and patients
Professionals allied to medicine such as physiotherapists, dietitians and podiatrists may be important in the ongoing management of some patients. In our own COPAT service, one of the medical consultants runs a busy weekly foot infection clinic with a podiatrist. Secretarial support to oversight, for example, discharge letters and clinic appointments, is also highly desirable, but not essential.