Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer.

OBJECTIVES: This study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics. SETTING: Outpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast of Scotland. PARTICIPANTS: Patients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6). OUTCOMES: Key behavioural determinants that influenced patients' behaviours relating to self-administration of intravenous antibiotics. DESIGN: Qualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed, reviewed for credibility and piloted. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using the TDF as the coding framework. RESULTS: The key behavioural determinants emerging as encouraging patients to self-administer intravenous antibiotics were the perceptions of being sufficiently knowledgeable, skilful and competent and that self-administration afforded the potential to work while administering treatment. The key determinants that impacted their decision not to self-administer were lack of knowledge of available options, a perception that hospital staff are better trained and anxieties of potential complications. CONCLUSION: Though patients are appreciative of the skills and knowledge of hospital staff, there is also a willingness among patients to home self-administer antibiotics. However, the main barrier emerges to be a perceived lack of knowledge of ways of doing this at home. To overcome this, a number of interventions are suggested based on evidence-based behavioural change techniques.

Pneumoperitoneum for neonatal laparoscopy: how safe is it?

We present the case of a 3 day old term neonate who experienced a cardiopulmonary arrest during creation of pneumoperitoneum for laparoscopic repair of duodenal atresia. The arrest was thought likely to have occurred as a result of a gas embolism. We discuss the features of the neonatal circulation which may predispose neonates to embolic phenomena during laparoscopic procedures, and the potential benefit of priming the insufflation apparatus with carbon dioxide. The possibility of gas embolism should be considered when contemplating laparoscopic surgery in this patient group.