Gilchrist Mark, Franklin Bryony Dean, Patel Jignesh P
Pharmacy Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W68RF, UK.
J Antimicrob Chemother. 2008 Jul;62(1):177-83. doi: 10.1093/jac/dkn152. Epub 2008 Apr 12.
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) 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 tool, so that the resulting OPAT map can be used to design an OPAT service where risk is minimized.
The study was undertaken using a consensus development panel to which the HFMEA process was applied. Key stakeholders in the local OPAT process were invited to join the HFMEA team with the aim of describing and agreeing (defined as 100% participant agreement) an OPAT map, its sub-processes and potential OPAT system failures.
The HFMEA 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.
An OPAT map was developed, which may serve as a practical model for other organizations setting up a similar service.
在英国，在病房环境之外给予胃肠外抗生素正成为一种治疗感染的有吸引力的方式。然而，门诊胃肠外抗生素治疗（OPAT）服务除了有许多优点外，也可能给相关工作人员和患者带来新的风险。在美国，医疗保健组织目前正在前瞻性地分析流程，试图使用医疗失效模式与效应分析（HFMEA）工具来防止错误发生。本研究的目的是使用HFMEA工具的第1 - 3步来规划并确定OPAT流程及子流程，并识别潜在的OPAT系统故障，以便最终得到的OPAT流程图可用于设计一个风险最小化的OPAT服务。
本研究采用共识发展小组进行，并应用了HFMEA流程。当地OPAT流程的关键利益相关者被邀请加入HFMEA团队，目的是描述并确定（定义为100%参与者达成一致）一份OPAT流程图、其子流程以及潜在的OPAT系统故障。
HFMEA团队在四次会议过程中识别出6个流程、67个子流程和217个可能的故障。OPAT流程图中确定的关键领域涉及识别和检查患者是否适合OPAT服务、多学科团队的参与以及健全的沟通渠道。
制定了一份OPAT流程图，它可能为其他建立类似服务的组织提供一个实用模型。
