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OPAT specialist nurse

The OPAT Specialist Nurse explains her role.
Hi. My name is Claire. I’m one of the nurse specialists based in the OPAT service in Glasgow. We are a team of four specialist nurses. We assess approximately 500 patients per year. We are a nurse-led clinic. And we either would train our patients to self-administer their antibiotics, if they have more than seven days left of therapy. Or we ask them to attend the clinic daily. I’m trained in placement of vascular devices and I’m anaphylaxis trained.
So we do the intial assessment of the patients after they’ve been referred by medical staff and this involves one of the team visiting the patient and discussing what will be expected of them and that includes either having to learn to self-administer, or having to attend the clinic daily. We also check that they still require antimicrobial therapy. And if there’s any other medical conditions that would stop them coming onto the service. We always explain to the patient what is expected of them when they join the OPAT service, whether this is learning to self-administer or attending the clinic. We also ensure that they know how important it is to attend for monitoring and what to do in an out of hours situation.
The specialist nurses and the OPAT team decide on what vascular device to use for each patient. This is dependent on the length of therapy and the type of antibiotic that they’re getting. The majority of the nurse specialist time is spent educating patients on how to administer antibiotics. This involves reconstituting the antibiotic from powder form, on managing their PICC line, and that includes any issues that they have with that, and on the safe disposal of sharps. The other part of the training for patients is warning them if something goes wrong what to do about it and who to contact. This usually involves having to see them in the clinic for the specialist nurses to try and troubleshoot.
The nurse specialists also have to ensure that the patient has appropriate transport to attend clinic. This may mean that we have to arrange hospital transport. For some patients, we would see them daily and assess their condition with a view to switching them to oral antibiotics, for example, our skin and soft tissue patients. Other patients, when they’re self-administering at home, we would see normally on a weekly basis. During this visit, we would check their vascular device. We would take off routine blood tests and occasionally, we have to send the patients for ECGs.
On arrival to clinic, we ask the patients how they’re coping with their antibiotics, if they’re managing, any side effects that they’re having and how we can then help them. We would then check their vascular device and change the exit site dressings. We take routine bloods of all our patients on a weekly basis. Occasionally, more often depending on results and depending on the condition that they’re attending us for. For our skin and soft tissue patients, we assess their area of infection daily for a view of when to switch them onto oral antibiotics. We also have to send patients for ECGs, depending on what antimicrobial therapy they’re on and if there’s interactions with their other oral medication.
On completion of OPAT, we always arrange to see the patients two weeks after to ensure that there’s been no backward steps in their therapy. Once a week, we have a multi-disciplinary team meeting. Involved in this is an infection specialist antimicrobial pharmacist, and the OPAT nurse specialists. We may also have trainee doctors, pharmacists, or nurses with us at the time. We then review each patient plan, during this, looking at microbiology, any reactions patients are having to the antibiotics. We also look to switch them from IV therapy onto oral therapy, or if there’s any issues, switch their IV antibiotics. We then confirm what specialist medical follow-up or any other monitoring that needs to be done for the patient.
My role as the lead nurse specialist for the OPAT service in Glasgow includes having to input all our data onto our database that we keep. From this, I will then produce reports which include clinical outcomes, any adverse complications from both drugs and from lines. This then leads on to further service planning.

The specialist OPAT nurse is a core member of the OPAT team.

The specialist nurse has developed expertise in assessment of appropriateness and suitability for home or clinic administration of parenteral antimicrobial therapy, choice and placement of vascular device, liaison and communication with the ward and OPAT medical teams and organisation of logistics around OPAT. In addition the specialist nurse is responsible with others in the OPAT team for outpatient monitoring of the patient and their clinical condition.

In this video Claire Vallance explains her role.

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OPAT: Outpatient Parenteral Antimicrobial Therapy

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