Background
Outpatient parenteral antimicrobial therapy (OPAT) requires that patients and their
caregivers administer antimicrobial medications in the home via venous catheters.
Hazards from physical attributes of the home environment may impede safe performance
of OPAT tasks.
Methods
We performed a qualitative study, including semistructured telephone interviews and
contextual inquiries, of patients performing OPAT tasks inside the home. Eligible
participants were discharged from 2 academic medical centers in Baltimore, Maryland,
on OPAT. We coded interview transcripts and contextual inquiry forms based on a model
of healthcare work systems.
Results
Twenty-nine patients underwent semistructured telephone interviews, and 14 patients
underwent contextual inquiry. We identified hazards including bathing, animal or pets,
extremes in temperature, household clutter, indoor soil and food exposures, outdoor
soil, and travel. Patients often developed strategies to mitigate these hazards.
Discussion
Multiple hazards related to the home environment could have led to harm, and in the
absence of specific guidance, patients developed strategies to mitigate these hazards.
Conclusions
Educational interventions to improve OPAT should incorporate an understanding of hazards
that may occur in the home environment.
Key Words
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References
National Home Infusion Association. The NHIA industry-wide data initiative phase I: 2010 NHIA provider survey comprehensive aggregate analysis report. Available from: http://www.nhia.org/Data/phase1.cfm. Accessed September 30, 2018.
- The 2016 infusion therapy standards of practice. 2017; 35: 10-18
- Medical devices in home health care.(editor)in: Olsen S The role of human factors in home health care: workshop summary. National Academies Press, WashingtonDC)2010: 145-172
- Introduction.in: Olsen S The role of human factors in home health care: workshop summary. National Academies Press, WashingtonDC)2010: 3-7
- The human factors of home health care: a conceptual model for examining safety and quality concerns.J Patient Saf. 2009; 5: 229-236
- The health care challenge: matching care to people in their home environments.in: Olsen S The role of human factors in home health care: workshop summary. National Academies Press, WashingtonDC)2010: 73-116
- Characterizing the nature of home care work and occupational hazards: a developmental intervention study.Am J Ind Med. 2014; 57: 445-457
- A qualitative study of difficult nurse-patient encounters in home health care.ANS Adv Nurs Sci. 2017; 40: 168-183
- Systems ambiguity and guideline compliance: a qualitative study of how intensive care units follow evidence-based guidelines to reduce healthcare-associated infections.Qual Saf Health Care. 2008; 17: 351-359
- Human factors systems approach to healthcare quality and patient safety.Appl Ergon. 2014; 45: 14-25
- SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients.Ergonomics. 2013; 56: 1669-1686
- Identifying challenges associated with the care transition workflow from hospital to skilled home health care: perspectives of home health care agency providers.Home Health Care Serv Q. 2015; 34: 185-203
- Identifying and categorising patient safety hazards in cardiovascular operating rooms using an interdisciplinary approach: a multisite study.BMJ Qual Saf. 2012; 21: 810-818
- Using human factors engineering to improve patient safety in the cardiovascular operating room.Work. 2012; 41(Suppl): 1801-1804
- Using health care failure mode and effect analysis: the VA National Center for Patient Safety's prospective risk analysis system.Jt Comm J Qual Improv. 2002; 28: 248-267
- Contextual design: defining customer-centered systems.Morgan Kaufmann Publishers, San FranciscoCA)1998
- Doing qualitative research.2nd ed. SAGE Publications, WashingtonDC)1999
- Environmental exposures and the risk of central venous catheter complications and readmissions in home infusion therapy patients.Infect Control Hosp Epidemiol. 2017; 38: 68-75
- Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.Nurse Educ Today. 2004; 24: 105-112
- Achieving saturation in thematic analysis: development and refinement of a codebook.Comprehensive Psychology. 2014; 3: 1-7
- Outpatient parenteral antimicrobial therapy today.Clin Infect Dis. 2010; 51: 198-208
Merwe S, Green H. What is the maximum temperature reached in elastomeric devices under simulated OPAT conditions? Arch Dis Child 2016;101:e2.
- Antibiotic stability related to temperature variations in elastomeric pumps used for outpatient parenteral antimicrobial therapy (OPAT).J Antimicrob Chemother. 2017; 72: 1462-1465
- Extended stability of antimicrobial agents in administration devices.J Antimicrob Chemother. 2017; 72: 1217-1220
- Safety risks among home infusion nurses and other home health care providers.J Infus Nurs. 2017; 40: 215-223
Mason M. Sample size and saturation in PhD studies using qualitative interviews. Available from: http://nbn-resolving.de/urn:nbn:de:0114-fqs100387. Accessed November 19, 2018.
- Validity, reliability, and generalizability in qualitative research.J Family Med Prim Care. 2015; 4: 324-327
Article info
Publication history
Published online: November 22, 2018
Footnotes
Previous presentation: Portions of this data were presented as an oral abstract at the Spring Conference for the Society for Healthcare Epidemiology of America, Portland, OR, April 20, 2018.
Funding/support: This work was supported by the Agency for Healthcare Research and Quality (1K08HS025782-01 to S.C.K.) and the Society for Healthcare Epidemiology of America Epi–Program (S.C.K).
Conflicts of interest: None to report.
Identification
Copyright
© 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
