An outpatient parenteral antibiotic therapy (OPAT) map to identify risks associated with an OPAT service

Objectives: Administering parenteral antibiotics outside the confines of a ward setting is becoming an attractive way of treating infections in the UK. However, as well as having many advantages, an outpatient parenteral antibiotic therapy (OPAT) service potentially introduces new risks to staff and patients involved. In the United States, healthcare organizations are now prospectively analysing processes to try and prevent errors occurring using the Healthcare Failure Mode Effect Analysis (HFMEA (TM)) tool. The objectives of this study were to map out and agree the OPAT process and sub-processes and to identify potential OPAT system failures using steps 1-3 of the HFMEA (TM) tool, so that the resulting OPAT map can be used to design an OPAT service where risk is minimized. Methods: The study was undertaken using a consensus development panel to which the HFMEA (TM) process was applied. Key stakeholders in the local OPAT process were invited to join the HFMEA (TM) team with the aim of describing and agreeing (defined as 100% participant agreement) an OPAT map, its sub-processes and potential OPAT system failures. Results: The HFMEA (TM) team identified 6 processes, 67 sub-processes and 217 possible failures over the course of four meetings. Key areas identified in the OPAT map concerned identifying and checking patient suitability for an OPAT service, involvement of a multidisciplinary team and robust communication channels. Conclusions: An OPAT map was developed, which may serve as a practical model for other organizations setting up a similar service.