scholarly journals THE IMPACT OF INFECTIOUS DISEASES OVERSIGHT ON OUTPATIENT PARENTERAL ANTIMICROBIAL THERAPY OUTCOMES IN CHILDREN

2020 ◽  
Vol 56 (S2) ◽  
pp. 21-21
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Therapy Outcomes ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Monitoring of Outpatient Parenteral Antimicrobial Therapy and Implementation of Clinical Pharmacy Services at a Community Hospital Infusion Unit

2014 ◽  
Vol 28 (5) ◽  
pp. 462-468 ◽  
Author(s):  
Punit J. Shah ◽  
Scott J. Bergman ◽  
Donald R. Graham ◽  
Stephanie Glenn
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Clinical Pharmacy ◽  
Hospital Readmissions ◽  
Therapeutic Drug ◽  
Serum Concentrations ◽  
Retrospective Case ◽  
Adherence To Guidelines ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Background: In 2004, the Infectious Diseases Society of America (IDSA) published monitoring guidelines for outpatient parenteral antimicrobial therapy (OPAT), but no assessment of their utilization has been reported. We evaluated adherence to these recommendations by physicians at infusion centers and then piloted a program of supervision of monitoring by pharmacists. Methods: Phase I: We performed a retrospective case–control study of patients who received OPAT over 1 year at 2 hospital infusion centers. Controls were patients treated by an infectious diseases (ID) physician, and cases were those without an ID physician. Patients were excluded if they received fewer than 3 days of OPAT. Clinical pharmacy monitoring services were then implemented for patients on OPAT prescribed by non-ID physicians at 1 hospital’s infusion unit. Two outcomes were measured: adherence to guidelines on monitoring and attainment of goal vancomycin and aminoglycoside serum concentrations when appropriate. The results for non-ID physicians were compared to both ID physicians and subsequently a pharmacist. Results: Ninety-nine patients were included in the retrospective study. Compared with patients who had ID physician supervision, the non-ID physicians who prescribed OPAT for 39 patients had lower adherence to monitoring recommendations (35.9% vs 68.3%, P = .003). No difference could be detected in achievement of goal vancomycin and aminoglycoside serum concentrations for the 14 cases and 19 controls requiring therapeutic drug monitoring (57.1% vs 68.4%, respectively, P = .765). Seven patients were enrolled in the study after pharmacy monitoring was implemented. Adherence to monitoring recommendations for these patients was significantly improved compared to the prior patients who lacked ID physician supervision (35.9% vs 100%, P = .0065). Conclusion: Non-ID physicians are less likely to monitor OPAT according to the IDSA guidelines than ID physicians; however, pharmacist oversight improves adherence to recommendations. Further studies of monitoring of OPAT by pharmacists should investigate the impact of pharmacist involvement on prevention of adverse events and hospital readmissions.

2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapya

2018 ◽  
Vol 68 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Anne H Norris ◽  
Nabin K Shrestha ◽  
Genève M Allison ◽  
Sara C Keller ◽  
Kavita P Bhavan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Healthcare Professionals ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infusion Catheter

Abstract A panel of experts was convened by the Infectious Diseases Society of America to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.

scholarly journals 756. Impact of Infectious Diseases Pharmacists as Part of an Interdisciplinary OPAT Team Managing Vancomycin

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S337-S338
Author(s):  
Meagan L Adamsick ◽  
Ronak G Gandhi ◽  
Samantha N Steiger ◽  
Monique R Bidell ◽  
Sandra B Nelson ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Adverse Drug Events ◽  
Massachusetts General Hospital ◽  
Intervention Group ◽  
Ambulatory Setting ◽  
Patient Specific ◽  
Control Group ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Number Of Patients ◽  
The Impact

Abstract Background Outpatient Parenteral Antimicrobial Therapy (OPAT) is a growing area of Infectious Diseases (ID) that allows for the treatment of severe infections in the ambulatory setting. Massachusetts General Hospital (MGH) incorporated inpatient ID pharmacists into the OPAT team in June 2017 to assist with vancomycin monitoring and dosing. Laboratory results were received and documented by the OPAT nurse and forwarded to the pharmacists for assessment via the electronic medical record (EMR). Pharmacists then sent clinical recommendations to the physician. This study aimed to determine the impact of pharmacists’ involvement in OPAT vancomycin management. Methods An EMR-generated report identified patients in the OPAT program from June 2016 through May 2017 as the control group and June 2017 through May 2018 as the intervention group. One hundred patients were randomly selected during each period. Patients were excluded from the intervention group if no pharmacist documentation was present. The primary outcome was to evaluate the proportion of vancomycin levels within the patient-specific goal range and secondary outcomes included the proportion of (1) pharmacists’ recommendations accepted by the ID physician and (2) patients who experienced adverse drug events. Results A total of 200 patients were evaluated. The most common indication for enrollment was osteomyelitis (46%). No differences in baseline characteristics were noted, and the median age was 67 years. The percentage of vancomycin levels within goal was significantly higher in the pharmacist-managed group compared with the control group (66.8% vs. 54.2%; P < 0.0001). The number of patients who experienced adverse drug events was similar between the two groups (39% vs. 43%; P = 0.66); however, fewer patients in the pharmacist group experienced acute kidney injury (5% vs. 13%; P = 0.08). Finally, 100% of pharmacist recommendations were accepted by ID physicians. Conclusion Leveraging inpatient ID pharmacists at MGH in the management of OPAT vancomycin provided improved percentage of vancomycin in therapeutic range and high acceptance rate of interventions. Further evaluation is necessary to assess the inpatient ID pharmacists’ workflow for implementation into other OPAT programs. Disclosures All authors: No reported disclosures.

scholarly journals Maximising the opportunity of a self‑administration outpatient parenteral antimicrobial therapy pathway

2021 ◽  
Vol 15 (1) ◽  
pp. 15-23
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Therapy ◽  
Patient Questionnaire ◽  
University Hospitals ◽  
Self Administration ◽  
Patient Response ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Nurse Empowerment ◽  
The University ◽  
The Impact

Background: The University Hospitals of Leicester NHS Trust outpatient parenteral antimicrobial therapy (OPAT) service has expanded rapidly with more nurse-led direction. Aims: A retrospective study between 1 July 2014 and 31 December 2019 was undertaken to assess the impact of OPAT expansion on beds released for further utilisation, clinical outcomes, adverse vascular access device (VAD) outcome, and self- and family-administered parenteral antimicrobial therapy. Method: Data were extracted from the OPAT Patient Management System and from a patient questionnaire survey. Findings: 1084 completed patient episodes were recorded in 958 patients, rising from 39 episodes in 2014 to 265 in 2019. The number of beds released for further utilisation correspondingly rose from 828 in 2014 to 8462 in 2019. The proportion of patients/family members trained to self-administer rose from 25% to 75%, with clinical cure/improvement of infection remaining high at between 84.6% and 92.8% of patients annually. Serious adverse VAD events remained low throughout. The patient response was generally positive. Conclusion: Nurse empowerment within OPAT can lead to significant improvements and patient benefits, while maintaining clinical outcomes.

Discharge Delays and Costs Associated With Outpatient Parenteral Antimicrobial Therapy for High-Priced Antibiotics

2019 ◽  
Vol 71 (7) ◽  
pp. e88-e93 ◽  
Author(s):  
Monica L Bianchini ◽  
Rachel M Kenney ◽  
Robyn Lentz ◽  
Marcus Zervos ◽  
Manu Malhotra ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Private Insurance ◽  
Hospital Costs ◽  
Care Facility ◽  
Transitions Of Care ◽  
Beta Lactam ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Subacute Care ◽  
Cost Effective Treatment ◽  
The Impact

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a widely used, safe, and cost-effective treatment. Most public and private insurance providers require prior authorization (PA) for OPAT, yet the impact of the inpatient PA process is not known. Our aim was to characterize discharge barriers and PA delays associated with high-priced OPAT antibiotics. Methods This was an institutional review board–approved study of adult patients discharged with daptomycin, ceftaroline, ertapenem, and novel beta-lactam-beta-lactamase inhibitor combinations from January 2017 to December 2017. Patients with an OPAT PA delay were compared with patients without a delay. The primary endpoint was total direct hospital costs from the start of treatment. Results Two-hundred patients were included: 141 (71%) no OPAT delay vs 59 (30%) OPAT delay. More patients with a PA delay were discharged to a subacute care facility compared with an outpatient setting: 37 (63%) vs 52 (37%), P = .001. Discharge delays and median total direct hospital costs were higher for patients with OPAT delays: 31 (53%) vs 21 (15%), P &lt; .001 and $19 576 (interquartile range [IQR], 10 056–37 038) vs $7770 (IQR, 3031–13 974), P &lt; .001. In multiple variable regression, discharge to a subacute care facility was associated with an increased odds of discharge delay, age &gt;64 years was associated with a decreased odds of discharge delay. Conclusions OPAT with high-priced antibiotics requires significant care coordination. PA delays are common and contribute to discharge delays. OPAT transitions of care represent an opportunity to improve patient care and address access barriers.

scholarly journals Patient Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Marie Yan ◽  
Marion Elligsen ◽  
Andrew E. Simor ◽  
Nick Daneman
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Retrospective Chart Review ◽  
Surgical Site Infections ◽  
Patient Characteristics ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Health Care Encounters ◽  
One Year ◽  
Alternative To Hospitalization

Outpatient parenteral antimicrobial therapy (OPAT) is a safe and effective alternative to hospitalization for many patients with infectious diseases. The objective of this study was to describe the OPAT experience at a Canadian tertiary academic centre in the absence of a formal OPAT program. This was achieved through a retrospective chart review of OPAT patients discharged from Sunnybrook Health Sciences Centre within a one-year period. Between June 2012 and May 2013, 104 patients (median age 63 years) were discharged home with parenteral antimicrobials. The most commonly treated syndromes included surgical site infections (33%), osteoarticular infections (28%), and bacteremia (21%). The most frequently prescribed antimicrobials were ceftriaxone (21%) and cefazolin (20%). Only 56% of the patients received follow-up care from an infectious diseases specialist. In the 60 days following discharge, 43% of the patients returned to the emergency department, while 26% required readmission. Forty-eight percent of the return visits were due to infection relapse or treatment failure, and 23% could be attributed to OPAT-related complications. These results suggest that many OPAT patients have unplanned health care encounters because of issues related to their infection or treatment, and the creation of a formal OPAT clinic may help improve outcomes.

Impact of a Multidisciplinary Team Review of Potential Outpatient Parenteral Antimicrobial Therapy Prior to Discharge from an Academic Medical Center

2011 ◽  
Vol 45 (11) ◽  
pp. 1329-1337 ◽  
Author(s):  
Brett H Heintz ◽  
Jenana Halilovic ◽  
Cinda L Christensen
Keyword(s):  
Central Venous Catheter ◽  
Hospital Discharge ◽  
Antimicrobial Therapy ◽  
Multidisciplinary Team ◽  
Cost Savings ◽  
Venous Catheter ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Impact

Background:: Outpatient parenteral antimicrobial therapy (OPAT) is frequently prescribed at hospital discharge, often without infectious diseases (ID) clinician oversight. We developed a multidisciplinary team, including an ID pharmacist, to review OPAT care plans at hospital discharge to improve safety, clinical efficacy, practicality, and appropriateness of the proposed antimicrobial regimen. Objective: To evaluate the impact of the OPAT team on regimen safety, efficacy, and complexity; calculate the economic benefits of the service by avoiding hospital discharge delay, central venous catheter placement, or need for OPAT; and evaluate the discharge environment among OPAT referrals. Methods: In an observational design, we analyzed the impact of an OPAT team from July 2009 through June 2010 at a large academic tertiary care hospital. All patients with plans for continued parenteral therapy after discharge referred to the OPAT team were included in the analysis. Patients were excluded if OPAT was cancelled prior to processing of the referral. Results: During the 1-year study period. 569 of 644 consecutive referrals to the OPAT team met inclusion criteria, resulting in 494 OPAT courses. Interventions by an ID pharmacist were made for safety (56%), regimen complexity (41%), and efficacy (29%). Lack of formal ID physician consultation resulted in more interventions for safety (64% vs 48%, p < 0.001) and efficacy (36% vs 21%, p < 0.001). Discharge delays were avoided for 35 referrals, resulting in 228 hospital days avoided and approximately $366,000 in hospital bed cost savings. Use of OPAT was avoided in 75 referrals (13.2%), preventing central venous catheter placement in 48 patients (8.4%), resulting in an additional $58,080 in cost savings. Conclusions: The OPAT team optimized safety, efficacy, and convenience of OPAT while providing substantial cost savings. Further studies are needed to confirm the program's cost-effectiveness.

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