Overview of Clinical Governance
Both the UK BSAC Good Practice Recommendations and the IDSA OPAT guidance recommend having good clinical governance practices together with outcome monitoring and the ability to manage risk.
It is recommended that OPAT patients should have a clear clinical and antimicrobial management plan with options and thresholds for escalation and de-escalation of treatment. Whilst antimicrobial choices within OPAT should be agreed by local stewardship programmes it is recommended that there is greater engagement and participation in the stewardship and infection prevention and control beyond the dictation of the antimicrobials available for OPAT.
These can include:
Reviewing key organisational outcomes such as readmission, OPAT infection failures, vascular device-related infections, S aureus bacteraemia and C. difficile infection. These data can help inform the organisation and stewardship programme and support or help refine antimicrobial choices and OPAT service delivery models. An example of an OPAT service’s review of vascular device related infections is included below.
Reviewing specific patient outcome groups is helpful to inform best practice and identify clinical factors that could guide OPAT practice including the frequency review and nature of monitoring. Outcome monitoring and predictors of OPAT failure in a series of patients managed with skin and soft tissue infections is included below.
Understanding the evolving antimicrobial resistance and specific local resistance data through an AMS programme as this is vital to guide prescribing in OPAT
Having a member of the OPAT service represented on the local stewardship committee or equivalent.
Establishing good practice links between primary and secondary care to ensure a joined up stewardship approach