OPAT – key decision in DH Start Smart Then Focus guidance

27 November

The UK OPAT Initiative is pleased to be able to provide practical support and audit tools for healthcare professionals and trusts working towards meeting the aims of the OPAT Department of Health/ARHAI Antimicrobial Stewardship programme – Start Smart – then FocusOPAT is formally acknowledged as one of the 5 decision options within the programme.

The guidance has been developed to improve appropriate prescribing of antimicrobials and to help healthcare providers assess whether they meet Criterion 9 of The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance which states:  “Procedures should be in place to ensure prudent prescribing and antimicrobial stewardship. There should be an ongoing programme of audit, revision and update. In healthcare this is usually monitored by the antimicrobial management team or local prescribing advisors”.   As such the Start Smart – then Focus approach is recommended for all antibiotic prescriptions:

Start smart is:

  • • Do not start antibiotics in the absence of clinical evidence of bacterial infection
  • • If there is evidence/suspicion of bacterial infection, use local guidelines to initiate prompt effective antibiotic treatment
  • • Document on drug chart and in medical notes: clinical indication, duration or review date, route and dose
  • • Obtain cultures first
  • • Prescribe single dose antibiotics for surgical prophylaxis; where antibiotics have been shown to be effective

Then Focus is: 

Review the clinical diagnosis and the continuing need for antibiotics by 48 hours and make a clear plan of action – the “Antimicrobial Prescribing Decision”

The five Antimicrobial Prescribing Decision options are:

  • • Stop
  • • Switch IV to Oral
  • • Change,
  • • Continue
  • • Outpatient Parenteral Antibiotic Therapy (OPAT)

The guidance is clear that review and subsequent decisions are clearly documented in the medical notes – for OPAT the Patient Management System provides HCPs and Trusts with a comprehensive and effective way of doing this.

To discuss the OPAT Patient Management System for your Trust, please contact Terri Martin on 01722 233000