Table 3.

Hazards in Patient-Described OPAT Goals.

Major Goal	Subgoal	Hazard
To be trained in catheter care and medication administration	Become informed about OPAT	Received misleading information in hospital
	Initiate start of care visit	No nurse arrived
	Instruct in OPAT task performance with verbal information	Rushed instruction Different nurses give different instructions Errors in instruction Patient did not understand training
	Task performed with supervision	Nurse did not watch patient perform OPAT task
	Receive written instruction about OPAT task performance	Instructions confusing Discharge information has differing information
	Receive guidance on managing the venous catheter during activities of daily living
	Receive instruction about troubleshooting
	Become accustomed to performing OPAT
Delivery of supplies and medications	Receive delivery	Uncertainty: What to do if patient not at home Delivery person didn’t wait for person to answer door
Administration of medication and catheter maintenance	Schedule infusions	Uncertainty: how strict the scheduling must be Misinformed about scheduling Frequent dosing
	Manage the duration of infusion	Rushes the infusion Takes longer than nurse says because of own decision making
	Clean the surface
	Set up supplies
	Clean hands	Ambiguity: hand sanitizer versus soap Ambiguity: to wear gloves or not Bandaged hand can’t be clean Gloves hurt ability to feel to do task Only one glove worn Rubbed sanitizer on gloves, not hands
	Access the catheter
	Keep the medication at an appropriate temperature	Instructions as to when to remove from refrigerator are confusing Unclear if medication needs to be refrigerated or not
	Administer the antimicrobial agent	Ambiguity: need for blood return
		Ambiguity: need to place on cap Can’t flush in steady stream because of poor strength or physical ailment Flushing hard to remember Different syringes and supplies delivered than what patient expected Physically difficult to attach medication Forgetting to unclamp line Wrong steps followed Forgets to flush out or creates more air bubbles Tubing too long Doesn’t swab hub long enough
	Stop the infusion	Unclear: if heparin needed in continuous infusion medications Forgetting to clamp line
	Dispose of waste
	Administer medication in syringe or elastomeric device: specific task	Unclear if infusion complete Infusion stopped early
	Prime the tubing when using mini-bags: specific task	Tubing touches floor
	Reconstitute antibiotic when using mini-bag: specific task	Complicated process Many steps required Needing more than 1 antimicrobial agent Reconstituted medication with wrong amount of sterile water
	Monitor infusion rate when using mini-bag: specific task	Difficult to time flow rate Pole difficult to set up Unclear if empty
	Program pump for continuous or intermittent infusion medication: specific task	Uncertainty: unclear when to start and stop pump Hard to do Nurse unable to help Not realizing pump is on Pump continues to beep
	Monitor power level on pump for continuous or intermittent infusion: specific task	Power cord stopped working Running out of power
Prevent harm to the venous catheter while performing activities of daily living	Bathe	Dressing cover does not fit appropriately
	Dress
	Care for pets	Pets jump on patient Pet waste
	Move around	Mobility device and line getting tangled or tugged
	Cook and clean
Troubleshoot	Identify when things may be going wrong
	Contact health care team when complications arise	Person on phone doesn’t understand the problem Difficulty understanding health care worker on phone Poor communication
	Assess for complications remotely	Understanding issues with clamps Understanding issues with medications being screwed on too tightly
	Assess for complications in the home
	Assess for complications in clinic	Unclear who can troubleshoot in clinic Lack appropriate tools to address complication in clinic Complication not addressed
	Attempt own troubleshooting	Patient panics
Monitor status on treatment	Change venous catheter dressing	Patient uncomfortable with troubleshooting dressing changes Each nurse does it differently Unclear who can change dressing
	Draw blood and send for laboratory testing
	Monitor of overall condition	Primary care doctor unaware of situation Can’t get to appointment because of mobility Infectious diseases doctor unsure of situation
	Remove catheter at end of therapy	Don’t know how to remove catheter Unsure who can order catheter removal

Abbreviation: OPAT, outpatient parenteral antimicrobial therapy.