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East & South East England Specialist Pharmacy Services
East of England, London, South Central & South East Coast
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Medicines Use and Safety
How to: Use the CQUIN framework for the development of an
Outpatient Parenteral Antimicrobial Therapy (OPAT) service
Introduction
The Commissioning for Quality and Innovation (CQUIN) framework enables commissioners to reward
excellence by linking a proportion of providers’ income to the achievement of local quality improvement
goals.1
There are many options for the delivery of antimicrobial therapy other than the inpatient setting; outpatient
or community clinics, community nursing in the patient’s residence, through home care with nurse
administration or self-administration by the patient. A multidisciplinary OPAT service, either in the acute or
community setting provides the structure for safer transfer and monitoring of these patients in the noninpatient setting.
The benefits of an OPAT service are well documented;
Improved patient choice and satisfaction2,3
Reduced risk of hospital acquired infection3
Improved antimicrobial stewardship4
QIPP efficiency gains from early discharge or avoided hospital admissions. OPAT episodes of care are
estimated to cost around 50% of equivalent inpatient costs.5
Background
A recent multi-centre audit of community IV therapy services across the East and South East of England
demonstrated that there was often inefficient and unsafe transfer of patients, from acute to community
services. Patients were sometimes discharged to community teams for the administration of IV antibiotics
without any follow-up arranged.7 Best practice recommends that these patients and community teams
should receive the support of a specialist OPAT multidisciplinary team to facilitate the safe transfer and
regular review of these patients. 8
The British Society of Antimicrobial therapy have produced OPAT Good Practice Recommendations that
describe the multidisciplinary team, governance tools and structures required to deliver a successful and high
quality OPAT service.8 An interactive toolkit for development of a local business case to set up an OPAT
service is also available together with an electronic patient management system to monitor the outcomes
from an OPAT service.9,10
Rationale
Development of an OPAT service is likely to result in significant cost savings and better patient experience but
there are also substantial costs incurred in establishing a specialist service of high quality. The aim of this
CQUIN framework is to provide the ‘pump-priming’ funding to establish the innovative service.
The OPAT business case toolkit will prompt the provider to identify the costs involved to set up and run the
service and to describe the benefits in terms of inpatient cost efficiencies and/or avoided hospital
admissions. Identification and development of further care pathways that utilise the delivery of IV therapy in
the non-inpatient setting will create a self-sustaining service for the future.
Points to consider:
Co-production between the provider and the commissioners is key to the successful design and
implementation of a CQUIN
Detailed information on PbR tariffs and local contracts will be required for the financial modelling
It is useful to identify a senior managerial ‘champion’ within the provider who will support the
clinicians with the development and implementation of the service
If considering using a commercial organisation to provide homecare services then a robust service
specification will be required
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Sample CQUIN Framework
Acute/Community providers
Goal Name
Indicator Number
Indicator Name
Indicator weighting
Description of Indicator
Numerator
Denominator
Rationale for Inclusion
Data source
Frequency of data
collection
Organisation responsible
for data collection
Frequency of reporting to
commissioner
Baseline period/date
Baseline value
Final indicator period/date
(on which payment is
based)
Final indicator value
(payment threshold)
Rules for calculation of
payment due at year end
Outpatient Antimicrobial Therapy (OPAT)
[]
Development of an Outpatient Antimicrobial Therapy (OPAT) service
[% of CQUIN fund available to this goal/indicator]
This CQUIN aims to support providers to develop an OPAT service that is in
line with best practice and will facilitate the safe early discharge or admission
avoidance for patients who are appropriate to receive antimicrobial therapy in
the non-inpatient setting
The number of patients administered IV antibiotics in a non-inpatient setting
who are receiving the standards of care outlined in the OPAT good practice
recommendations (Q3 onwards)
The number of inpatients assessed as appropriate to receive IV antibiotics in a
non-inpatient setting
(See introduction and rational above)
Provider’s OPAT database 10
Business case in Q1, Progress report on project implementation in Q2,
Monthly outcome data from the beginning of Q3 onwards
Provider
Quarterly for Q1 -Q2
Monthly for Q3 -Q4 (see below)
Q1
£X to be negotiated by provider and commissioner (suggest between £25K £75K)
Q4
£X to be negotiated by provider and commissioner (suggest between £175K £250K)
The CQUIN payment could be triggered in stages – see below
Milestones:
Date/Period
Rules for Achievement of milestones
Reporting
Deadline
Q1
Provide commissioners with model and business plan for an
OPAT service using the OPAT business case Toolkit 9
Put in place governance tools and service in line with OPAT
Good practice recommendations8
Run pilot and provide monthly monitoring data using the
OPAT Patient Management system10
Evaluate pilot (including patient satisfaction survey) and
continue to provide monthly data to year end with a target of
providing proof that it is a financially sustainable service.
End of Q1
%weighting
for payment at
100%
10%
End of Q2
20%
Q3
30%
Q4
40%
Q2
Q3
Q4
CQUIN Framework for OPAT service – October 2012 Vs1 (EC)
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Quarter 1: Business case
Set up OPAT project stakeholder group to design the OPAT service and identify patient groups and care
pathways that could utilise OPAT services. The provider will be required to present an internally approved
business case to the commissioners outlining the service design and costs/benefits analysis, by the end of Q1.
Quarter 2: Development of governance tools
Develop the governance tools required for an OPAT service in line with best practice recommendations;
policies, procedures, staff training, etc. Recruitment or redeployment of existing staff may be necessary.
Quarter 3: Pilot phase
Run a pilot service for a 3-6 month period seeing the minimum number of patients outlined in the business
case. Use the OPAT Patient Management database to collate monthly outcomes and present these to the
contractual Clinical Quality review meetings.
Quarter 4: Evaluation and Outcomes reporting
Evaluate and continue the OPAT service to year end. The evaluation will be expected to demonstrate how the
service will be sustained for future years and may include the development of further care pathways that
utilise the OPAT service. It should also include a patient satisfaction survey.
References:
1.
Department of Health (2008) Using the Commissioning for Quality and Innovation (CQUIN) Framework
2.
Kayley, J. (2008) Effective practice in community IV therapy. British Journal of Community Nursing. 13; 7: 323-4,
326-8
3.
O’Hanlon S et al (2008) Delivering intravenous therapy in the community setting, Nursing Standard 22; 31: 44-
4.
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Department of Health. Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection
(ARHAI) (2011) Antimicrobial stewardship: Start smart - then focus. Link to DH Start smart - then focus (Accessed
August 2012)
5.
Chapman ALN et al (2009) Clinical efficacy and cost effectiveness of outpatient parenteral antibiotic therapy
(OPAT): a UK perspective. J Antimicrob Chemother64:1316.
6.
Lomas C. (2009) Nurse-led community IV therapy services save the NHS over one million in three years. Nursing
Times 3 February 2009
7.
Callaghan E. The Medicine Use and Safety Division of the East and South East England Specialist Pharmacy
Service (2012). Community Intravenous Therapy. An audit of prescribing and administration. Link to audit
report on NeLM (Accessed August 2012)
Available Resources:
8.
British Society for Antimicrobial Chemotherapy (2012). Good Practice Recommendations for outpatient
parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement Available at:
http://jac.oxfordjournals.org/content/early/2012/01/31/jac.dks003.full.pdf+html (Accessed Aug 12)
9.
British Society for Antimicrobial Chemotherapy. OPAT Business case Toolkit Link to Toolkit (Accessed Aug 2012)
10. British Society for Antimicrobial Chemotherapy. OPAT Patient Management System Link to Information on
database (Accessed Aug 2012)
©East & South East England Specialist Pharmacy Services
CQUIN Framework for OPAT service – October 2012 Vs1 (EC)
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