Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy

Sara Keller, Sara Cosgrove, Alicia Arbaje, Rachel Huai En Chang, Amanda Krosche, Deborah Williams, Ayse Gurses

Research output: Contribution to journalArticle

Abstract

Background: Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. Methods: A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. Results: Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing “high-skilled tasks.” Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. Conclusion: Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.

Original languageEnglish (US)
JournalJoint Commission Journal on Quality and Patient Safety
DOIs
StateAccepted/In press - Jan 1 2019

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Caregivers
Outpatients
Therapeutics
Delivery of Health Care
Health Facility Moving
Interviews
Patient-Centered Care
Human Engineering
Task Performance and Analysis
Home Care Services
Workload
Patient Care
Catheters
Safety

ASJC Scopus subject areas

  • Leadership and Management

Cite this

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title = "Roles and Role Ambiguity in Patient- and Caregiver-Performed Outpatient Parenteral Antimicrobial Therapy",
abstract = "Background: Complicated medical therapies traditionally performed in acute care hospitals are increasingly moving to the home, requiring patients and informal caregivers to perform complicated medical tasks. For example, in outpatient parenteral antimicrobial therapy (OPAT), patients and caregivers perform antimicrobial infusions and venous catheter care. The objective of this study was to characterize patient understanding of patient, caregiver, and health care worker roles in OPAT and barriers to fulfilling these roles, with the goal of understanding how to best support patients and their caregivers. Methods: A qualitative study using 40 semistructured telephone interviews and 20 contextual inquiries of patients and caregivers performing OPAT tasks was performed. Eligible participants were discharged from two academic medical centers on OPAT. Interview transcripts and notes from contextual inquiry were coded based on a human factors engineering model. Results: Four main roles are described: communicator, advocate, learner-trainer, and lay health care worker doing “high-skilled tasks.” Patients and caregivers experienced role ambiguity about OPAT task performance at the time of hospital discharge. Patients noted that their health care workers experienced role ambiguity as well, particularly regarding who was managing their care. Patients and caregivers used role transitions to achieve workload management, in which patients and caregivers transitioned OPAT tasks or non-OPAT tasks from one person to another. Conclusion: Clear delineation of roles in complicated home-based medical therapies and training of all who may perform these tasks could improve the safety and quality of home-based care.",
author = "Sara Keller and Sara Cosgrove and Alicia Arbaje and Chang, {Rachel Huai En} and Amanda Krosche and Deborah Williams and Ayse Gurses",
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AU - Krosche, Amanda

AU - Williams, Deborah

AU - Gurses, Ayse

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