Developing an OPAT service that meets the ever-changing needs of patients

Although I didn't know it at the time, in 2015 I was fortunate enough to land my ‘dream job’: setting up an outpatient parenteral antimicrobial therapy (OPAT) service along with two medical consultants at Wythenshawe Hospital, a large tertiary hospital in Manchester. The project was initially a 6-month pilot to see whether there was a place for this type of service in the organisation, so the pressure was on from the beginning to ensure that we did things right! The purpose of OPAT is to treat patients with infections as close to their own home as possible and, although there are various ways in which treatments can be offered, the majority of OPAT patients require intravenous (IV) therapy and therefore IV access.

The vascular access options available to our OPAT patients in 2015 were limited to either peripheral cannula or peripherally inserted central catheters (PICC), which were inserted by the interventional radiology (IR) department. Although, in theory, these choices seemed perfectly acceptable, the reality was that many medications prescribed by the OPAT service required central venous access (due to pH, osmolarity, requirement for frequent blood sampling, duration of treatment etc) and, in a large tertiary hospital with multiple specialist services, the demand for PICC insertions was high. This invariably resulted in lengthy delays for PICC insertions, which had implications for our new service.