Using a Pictorial Mat to Improve Patient Knowledge and Confidence About Performing OPAT: A Quality Improvement Project

Background: The medical care of persons with chronic infection often involves the use of outpatient parenteral antibiotic therapy (OPAT). Benefits include significantly reduced hospitalization cost, days of hospitalization, and hospital-acquired infections, as well as improved quality of life. OPAT risks include increased incidence of vascular and antimicrobial complications. High-quality patient education has been found to be critical for high-quality OPAT programs in reducing risks.

Methods: This quality improvement (QI) project will utilize the plan-do-study-act (PDSA) cycle and a newly developed pictorial OPAT mat as an intervention to potentially improve patient education in our infectious disease clinic related to knowledge and confidence in performing OPAT.

Procedure:
Plan: Using a convenience sample, investigators will assess the patient’s self-rating of knowledge and confidence about their ability to perform OPAT using an investigator-developed, 14-item survey (OPAT knowledge and confidence scale [OKCS]). The sample will be divided into 2 groups: the standard care group (SC) (demonstration-return demonstration/teach-back) and the standard care + OPAT mat group (SC+OM) (demonstration-return demonstration/teach-back + OPAT mat).
Do (data collection): In the first month of the study, an investigator provided SC to all hospitalized patients who consented to participate. All consenting participants received SC+OM in the second month. All participants completed a REDCap electronic survey version of the OKCS at the time of consent, after teaching, and before hospital discharge. This project was reviewed and approved by a university-based institutional review board.
Study (data analysis): Frequencies were used to examine group differences. The overall mean score for the OKCS was 3.67/5.0. 59 subjects consented to participate in this project. 33 participants were in the SC group and 26 participants comprised the SC+OM group. The overall mean score for the OKCS was 3.45 for the SC group and 3.89 for the SC+OM group. Participants in the SC+OM group had higher scores on 11/14 items on the OKCS. The item with the lowest score in both groups was Q6: I know what to do if the medication administration line is sluggish or hard to flush (SC= 3.00 vs SC+OM= 3.42).
Act (conclusions): Participants demonstrated greater knowledge and confidence in performing OPAT when the OPAT mat was added to our standard teaching practices. Results indicate a need to particularly focus teaching on troubleshooting potential problems that may occur in OPAT administration.