OPAT Care Plan (Initial)

Initial OPAT Care Plan

Date/Time: [Date and time]

Author: [Author name and credentials]

OPAT Service Contact: [Team name]; [Clinic phone]; [After-hours/on-call pathway]

Care Setting: [home self-admin / home with visiting nurse / infusion center / SNF / LTACH]

Referring Service: [Referring team or service]

Activation Status: OPAT NOT YET ACTIVATED — [Gating items and responsible owners] (Only include this line if OPAT is not yet finalized due to pending access, insurance, medication delivery, or teaching barriers.)

Therapy Snapshot

• Indication: [Primary infectious diagnosis with anatomic site; bacteremia clearance date if applicable]
• Access: [Device type; laterality/site; placement date]
• Therapy: [Antimicrobial(s) with dose and frequency]; Start [date]; Planned stop [date or duration rule]
• Monitoring: [Lab panels and frequency]; [Who draws]; [Who reviews]; [Key escalation triggers]
• Next follow-up: [Date]; [Clinic/virtual]; [Provider or service]

Indication and Infectious Syndrome

[Brief narrative of primary infectious diagnosis with anatomic site and severity, date of onset/diagnosis, key milestones (bacteremia clearance date, source control procedure dates), and rationale for IV therapy in the outpatient setting. Include relevant OPAT-risk comorbidities (renal disease, heart failure, immunocompromise, prior line complications) only if documented.]

Microbiology: [Culture source(s) and collection date(s); organism(s); key susceptibilities]. (If pending, state "Pending," list interim assumptions guiding therapy, and specify reassessment plan with owner and date. If negative, note what was obtained and limitations.)

Source Control: [Procedures performed and dates; residual hardware or collections; planned interventions with dates and responsible service].

Antimicrobial Plan

(Create a separate subsection for each antimicrobial. Use calendar dates. If any critical item is unknown, mark "TBD before first outpatient dose" and assign an owner.)

[Medication Name]

• Indication and regimen: [Indication]; [Dose, route, frequency]; [Infusion method/duration if applicable]
• Dates/duration: Start [date]; Planned stop [date] ([duration definition, e.g., "6 weeks from first negative blood culture on date"])
• Dosing basis: [CrCl/eGFR value and date]; [Weight]; [Dialysis status if applicable]
• TDM plan: [Parameter (AUC/trough)]; [Target range]; [Sampling timing]; [Adjustment owner] (Only include if therapeutic drug monitoring required.)
• Drug interactions: [Relevant interaction(s) for this patient]; [Action plan and responsible owner]
• Oral step-down plan: [Criteria to transition]; [Candidate agent(s)] (Only include if oral step-down anticipated.)

(Repeat medication subsection for each additional antimicrobial.)

De-escalation Plan: [Triggers for narrowing (culture finalization, clinical improvement)]; [Stop rules if alternate diagnosis established]; [Owner and review date].

IV Access

Device/Status: [PICC / tunneled CVC / port / midline]; [In place / planned]; [Laterality/site]; [Lumens]; [Placement date]; [Tip confirmation if applicable]

Maintenance: [Dressing change frequency and by whom]; [Flush/lock protocol]; [Blood draw permissions]

Complication Surveillance: Symptoms to report: site pain/swelling, inability to flush, leakage, fever during infusion, redness/drainage. After-hours contact: [pathway and numbers].

Line Removal Plan: [Who removes]; [Timing relative to therapy end]; [Location/setting].

Monitoring Plan

Baseline Values: [Serum creatinine with calculated CrCl/eGFR]; [Hepatic panel]; [CBC]; [Other baseline values relevant to dosing/safety].

Serial Lab Monitoring: (Use standardized day(s) of week. For each test, specify draw location, who orders, who reviews with expected review window, and action thresholds with escalation pathway.)

• [Test name]:

  • Frequency/day: [e.g., weekly on Mondays]
  • Draw location: [Home nurse / infusion center / outpatient lab]
  • Ordered by: [Ordering clinician/service]
  • Reviewed by: [Reviewer]; Review window: [e.g., within 1 business day]
  • Action thresholds: [Specific thresholds and actions: hold / dose adjust / ED referral]; Escalation: [Contact pathway]

(Repeat for each monitored lab or drug level. For TDM, include parameter, target range, sampling timing relative to dose and steady state, and adjustment owner.)

Clinical Monitoring:

• Visit cadence: [Clinic / virtual / nursing visit frequency]
• Assess at each contact: [Infusion reactions; GI symptoms; rash; line site; clinical response markers; adherence]

Follow-up and Coordination

• ID/OPAT follow-up: [Date/time or scheduling owner]
• Other specialty follow-up: [Service and date] (Only include if relevant to source control or duration decisions.)
• Repeat imaging/cultures: [Study]; [Date]; [Purpose]; [Ordering provider] (Only include if planned.)
• Home infusion pharmacy: [Pharmacy name]; [Contact for delivery issues or pump malfunction]
• Visiting nurse: [Agency]; [Visit frequency]; [Scope of tasks] (Only include if applicable.)

End-of-Therapy Plan: [Last dose date verification]; [Line removal plan and timing]; [Final labs/assessment]; [Oral suppressive therapy if planned]; [Communication plan to referring service and PCP].

Medication Reconciliation

Medication list reconciled [date].

• OPAT-critical interactions: [Anticoagulants, nephrotoxins, QT-prolonging agents, immunosuppressants with action plans] (Only include interactions present for this patient.)
• Allergies: [Allergen(s) and reaction(s)]; [Relevance to selected antimicrobials]

(Use calendar dates throughout. For conditional durations, include both tentative stop date and confirming criteria. For missing critical information, use "TBD before [milestone]" with assigned owner. For pending data, state "Pending" with interim assumptions and reassessment plan. Omit subsections that are not applicable. Do not infer organisms, susceptibilities, or stop dates not explicitly documented.)