Delivery, setting and outcomes of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): a scoping review

Abstract

BackgroundThere has been little detailed systematic consideration of the delivery, setting and outcomes of paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT), although individual studies report that it is a safe and effective treatment.ObjectiveThis scoping review aimed to examine what is known about the delivery, settings and outcomes of paediatric OPAT and to identify key knowledge deficits.DesignA scoping review using Arksey and O’Malley’s framework was undertaken.Data sourcesKeywords were identified and used to search MEDLINE and CINAHL.Study appraisal methodsPrimary research studies were included if samples comprised children and young people 21 or under, who had received OPAT at home or in a day treatment centre. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studiesMain findingsFrom a preliminary pool of 157 articles, 51 papers were selected for full review. 19 studies fitted the inclusion criteria. Factors influencing delivery of OPAT were diverse and included child’s condition, home environment, child-related factors, parental compliance, training and monitoring. There is little consensus as to what constitutes success of and adverse events in OPAT.ConclusionsFuture studies need to clearly define and use success indicators and adverse events in order to provide evidence that paediatric OPAT is safe and effective.ImplicationsConsensus outcomes that include child and parent perspectives need to be developed to allow a clearer appreciation of a successful paediatric OPAT service.

Safety of Nurse- and Self-Administered Paediatric Outpatient Parenteral Antimicrobial Therapy

“…This is a common limitation of studies assessing the safety and efficacy of paediatric OPAT. In a recent scoping study, 8 of 19 included studies included ≤100 episodes [21]. Our sample size is consistent with a previous study examining the safety and efficacy of OPAT services in adults at another tertiary hospital in Adelaide, South Australia [13].…”

Paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): An e-survey of the experiences of parents and clinicians

“…Whilst there is a developing body of evidence addressing the clinical outcomes of children requiring OPAT [4,10], it is also clear that there is a real deficit of evidence about the experiences of children and their parents [15] and almost no literature considering the perspectives of clinicians. This study addresses this deficit by exploring these perspectives.…”

“…Although antimicrobial treatment at home was generally preferred by the parents and children, a significant proportion of parents were worried that something might go wrong at home, although little detail was provided about how extensive these worries were. The evidence suggests that OPAT is safe [15]; however, reassurance from professionals about the safety of OPAT at the time of referral and ongoing support from the OPAT nurses, cannot necessarily allay these worries. Findings from the qualitative component of this study reveal that parents worried about aspects of care such as displacement of lines and concerns about…”

Being ‘at-home’ on outpatient parenteral antimicrobial therapy (OPAT): a qualitative study of parents’ experiences of paediatric OPAT

“…The growing evidence about the clinical outcomes of OPAT for children2 5 10 has overlooked the perspectives and experiences of children and their parents12 and a mix of methodological issues and the age of the studies limits the utility of this evidence to current practice. The suggested standardised survey for routinely collecting patient/parent satisfaction1 is unlikely to generate the range and depth of experience that will illuminate practice.…”

“…Reported benefits of OPAT include cost-effectiveness,11 and child/parent satisfaction and well-being 1. However, there is a lack of consensus about what constitutes success, the definition and reporting of adverse events, and the evidence base for the economic benefits of paediatric OPAT 12. Across all OPAT literature, patient experience is mostly limited to survey data;13 14 the limited robust qualitative evidence in adults reveals that despite good clinical outcomes, some OPAT experiences can be troubled and challenging 15…”