How do we do it?
At Hull University Teaching Hospitals NHS Trust we run three dedicated nurse-led clinics each week seeing up to six patients in each clinic.
Patients are also seen at other times if they are unable to attend one of our fixed-time clinics, or if they require closer monitoring or when clinics are at capacity. No doctors attend these clinics, but senior doctors are always available by phone to discuss arising problems.
All patients are discussed at a weekly combined OPAT-COPAT MDT meeting (doctors, nurses and a pharmacist) when weekly bloods, emerging problems, the clinical management plan and follow-up arrangements are discussed and agreed and prescriptions for the following week are also written.
Medical reviews occur within the COPAT service as clinically indicated e.g. if an adverse effect occurs, towards the end of a planned course of therapy or if the patient is not clinically improving as well as was expected.
At each visit, patients are asked a series of questions to establish if they are tolerating their antibiotic regimen. Our standard questions cover the following areas:
• Shivers, shakes, chills or fever
• Nausea, vomiting or loose stools
• Eating and drinking
• Mouth or tongue problems (including a brief examination)
• Peripheral neuropathy
• Changes to medications – prescribed or otherwise
• Wound problems (if applicable) including examination and consented photographs for future reference and weekly MDT meeting
• Other arising issues
Patients are also weighed and have their basic observations recorded in the case-notes (temperature, blood pressure, pulse, respiratory rate and oxygen saturations).
Blood is taken for a full blood count, biochemical profile and C-reactive protein and other tests (e.g. haematinics, urine, glucose and wound swabs for culture) are performed as clinically indicated.
If there is concern from the prior MDT meeting about a certain test (e.g. a patient’s haemoglobin) then bloods are sent for urgent testing and the patient either waits so a clinical decision can be made prior to leaving the COPAT area or is phoned by one of the COPAT nursing team later that day about the result.
This above list is not exhaustive. Careful follow-up probing questions may be required to establish if, for example, new symptoms started before or after the infection being treated and/or commencement of antibiotic therapy.