scholarly journals 601. Assessment of a Nursing and Pharmacy Collaborative Outpatient Parenteral Antimicrobial Therapy Management Program

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S403-S403
Author(s):  
Alice N Hemenway ◽  
Rebecca L Stewart
Keyword(s):  
Patient Education ◽  
Patient Outcomes ◽  
Antimicrobial Therapy ◽  
Hospital Admissions ◽  
Management Program ◽  
Collaborative Management ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Positive Effects ◽  
Phone Calls ◽  
Ed Visits

Abstract Background At our facility a collaborative team of nurse and pharmacist manage patients receiving outpatient parenteral antimicrobial therapy (OPAT). This project aims to characterize this collaboration and assess the effectiveness by reviewing interventions made by the nurse and pharmacist, and assessing patient outcomes such as OPAT or infection related hospital admissions or ED visits, infection clearance, and mortality. Methods A retrospective cohort study was performed on patients started on OPAT between 1/1/19 and 12/31/20. This time period was split into three: Period 1 where the clinic only included the PharmD and they saw patients for in-person appointments, Period 2 where the clinic included both the OPAT RN and PharmD and the PharmD performed in-person appointments, and Period 3 where the clinic included both but due to COVID the in-person PharmD appointments were on hold. OPAT or infection related hospital admissions, ED visits, infection clearance, and death were compared for each period. Results A total of 388 patients were included in the review. There were 158 (40.7%) and 148 (38.1%) OPAT-related phone calls from the PharmD and RN, respectively. The two most common reasons for both PharmD and RN phone calls were a medication stop order/confirmation, and weekly lab obtainment. The third most common reason for the PharmD was dose change, and for the RN it was patient education. During Periods 1 and 2 the PharmD had in-person appointments with 28.9% of patients. The overall OPAT/infection related hospital admission and ED visit rates were 7.7% and 5.4%, respectively. Periods 2 and 3, which utilized the combined efforts of RN and PharmD, had consistently lower hospital admissions related to OPAT/infection (46-50% vs 62% Period 1), and ED visits due to OPAT/infection (33-36% vs 47% for Period 1). Clearance of infection was high for all 3 periods (89-95%), and mean mortality was low (2.1%). Conclusion Collaborative management allowed for the nurse and pharmacist to function as substitutes for each other without losing the specific focus of their specialties, with the RN performing more patient education, and the PharmD performing more medication dosing. The collaboration had positive effects on OPAT patient outcomes. Disclosures All Authors: No reported disclosures

scholarly journals 597. Comparison of Vancomycin and Daptomycin Complications and Interventions in Outpatient Parenteral Antimicrobial Therapy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S361-S362
Author(s):  
Monark Nakrani ◽  
Diana Yu ◽  
Monica Sikka ◽  
James Lewis ◽  
Alyse Douglass ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Phone Calls ◽  
Ed Visits ◽  
The Difference ◽  
Vancomycin Group

Abstract Background Vancomycin and daptomycin are commonly used in outpatient parenteral antimicrobial therapy (OPAT) for patients requiring lengthy courses of intravenous antimicrobials who are otherwise stable for discharge. Balancing the convenience and cost-savings of OPAT with the potential for adverse effects is challenging, this study compared the rates of complications and antimicrobial interventions for patients receiving vancomycin versus daptomycin across multiple OPAT settings. Methods We performed a retrospective chart review of adult OPAT patients who received >72 hours of vancomycin or daptomycin via home infusion, infusion center, or skilled nursing facility between January 2017 and August 2019. The outcomes evaluated included the rates of adverse drug reactions (ADRs), laboratory results above a defined threshold (vancomycin levels >20 mg/mL in the vancomycin arm and creatinine phosphokinase (CPK) levels >500 units/L in the daptomycin group), line complications, emergency department (ED) visits, and hospital readmissions. Other outcomes included additional phone calls and interventions required to coordinate care (additional labs, assessment of symptoms, additional test or antimicrobial-related dose changes) by the OPAT team. Results 180 patients were included; 130 received vancomycin and 50 received daptomycin. (Table 1) Patients in the vancomycin group had more supratherapeutic vancomycin troughs than elevated CPK for patients in the daptomycin group (rate ratio [RR] 0.16, 95% CI 0.05-0.50, p=0.0018). Rates of interventions (RR 0.37, 95% CI 0.26-0.52, p< 0.0001) and additional phone calls (RR 0.56, 95% CI 0.43-0.72, p< 0.0001) were also higher for patients in the vancomycin group. There were no statistically significant differences between groups in the rates of ADRs, line complications, ED visits, or hospital readmissions. (Table 2) Table 1. Baseline Characteristics Table 2. Outcomes Conclusion Vancomycin-treated patients had significantly more laboratory abnormalities and required significantly more time in patient care coordination by the OPAT team. The difference in healthcare utilization between these groups suggests a potential for significant cost-savings for OPAT patients and the healthcare system. Disclosures All Authors: No reported disclosures

scholarly journals Emergency Department Utilization During Self-Administered Outpatient Parenteral Antimicrobial Therapy

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S332-S332
Author(s):  
Anisha Ganguly ◽  
Larry Brown ◽  
Deepak Agrawal ◽  
Kavita Bhavan
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Antimicrobial Therapy ◽  
Hospital Admissions ◽  
Hospital Charges ◽  
Emergency Department Utilization ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Before And After ◽  
Ed Visits ◽  
Hospital To Home

Abstract Background Self-administered outpatient parenteral antimicrobial therapy (S-OPAT) has been established as a clinically safe and effective alternative to inpatient or outpatient extended-course intravenous antibiotics while reducing healthcare resource utilization. However, previous research has not confirmed that transferring patients from the hospital to home for treatment does not cause a compensatory increase in emergency department (ED) visits. We sought to validate S-OPAT clinical safety and healthcare costs associated with S-OPAT by confirming that S-OPAT does not increase ED utilization during treatment. Methods We conducted a before-after study of ED utilization among S-OPAT patients. We compared ED visits, hospital admissions resulting from ED visits, hospital admissions due to OPAT-related causes, and hospital charges associated with all ED visits 60 days before and after initiation of S-OPAT. A 60-day time frame was selected to effectively encompass the maximum treatment duration (8 weeks) for S-OPAT. Paired t-tests were used to compare the change in ED utilization before and after initiation of S-OPAT. Results Among our cohort of 944 S-OPAT patients, 430 patients visited the ED 60 days before or after starting treatment. Of the patients with ED visits, 69 were admitted to the hospital for OPAT-related causes and 228 incurred hospital charges from their visit. Initiation of S-OPAT was associated with a statistically significant reduction in total ED visits, all-cause hospital admission, OPAT-related hospital admission, and hospital charges (see Table 1). Conclusion Our review of ED utilization among S-OPAT patients demonstrates a reduction in multiple parameters of ED utilization with the initiation of S-OPAT treatment. Our findings confirm that S-OPAT does not yield an increase, but rather a decrease, in ED visits with the transfer of patients from hospital to home. Disclosures All authors: No reported disclosures.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals Current Status of Outpatient Parenteral Antimicrobial Therapy (OPAT) At a University-Affiliated Acute-Care Hospital in The Republic of Korea

2021 ◽  
Author(s):  
Eunjeong Heo ◽  
Yoonhee Choi ◽  
Hyung-sook Kim ◽  
Hyung Wook Namgung ◽  
Eunsook Lee ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Management Program ◽  
Republic Of Korea ◽  
Current Status ◽  
Care Hospital ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
The Republic ◽  
Tract Infections

Abstract Objectives The aim of this study was to describe current status of outpatient parenteral antimicrobial therapy (OPAT) at a tertiary care hospital in the Republic of Korea. Methods This retrospective study was conducted on outpatients and referral patients who had a prescription of parenteral antibiotics from July to December 2019. We reviewed the prescribed antimicrobials, the indication of antimicrobial therapy, where patients administered antimicrobial injection and management of pre- and post- prescriptions. Results Of the 577 episodes included in this study, 399 (69.2%) were delivered by referral model, 178 (30.8%) by outpatient model. About 70% of OPATs were prescribed in the pulmonology, infectious diseases, orthopedics, gastroenterology, and hematology departments. Five antibiotics (ertapenem (26.0%), ceftriaxone (12.8%), kanamycin (11.8%), amikacin (10.1%), and cefazolin (8.5%)) accounted for 69.2% of the total OPATs. Urinary tract infections (27.3%), respiratory infections (20.8%), and intra-abdominal infections (15.9%) are the most frequent indications of OPAT. After prescription, there were 295 (73.9%) follow-up visits in referral model and 150 (84.3%) in outpatient model (p<0.05). Laboratory tests necessary for monitoring were totally performed in 274 (47.5%). Conclusions We found that significant number of OPAT was prescribed, follow-up visits were not performed in about a quarter of episodes, and laboratory monitoring was not fully conducted in more than half of the cases. Therefore, it is necessary to establish an appropriate management program for OPAT. Considering limited resources and the distribution of OPAT prescriptions, it may be effective to select frequently used antibiotics or frequently prescribed departments and start the program for them.

Failure modes and effects analysis to improve transitions of care in patients discharged on outpatient parenteral antimicrobial therapy

2021 ◽  
Author(s):  
Eleanor D Sadler ◽  
Edina Avdic ◽  
Sara E Cosgrove ◽  
Dawn Hohl ◽  
Michael Grimes ◽  
...  
Keyword(s):  
Patient Education ◽  
Antimicrobial Therapy ◽  
Failure Modes ◽  
Task Force ◽  
Transitions Of Care ◽  
Process Maps ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Targeted Interventions ◽  
Electronic Order ◽  
Order Set

Abstract Purpose To identify barriers to safe and effective completion of outpatient parenteral antimicrobial therapy (OPAT) in patients discharged from an academic medical center and to develop targeted solutions to potentially resolve or improve the identified barriers. Summary A failure modes and effects analysis (FMEA) was conducted by a multidisciplinary OPAT task force to evaluate the processes for patients discharged on OPAT to 2 postdischarge dispositions: (1) home and (2) a skilled nursing facility (SNF). The task force created 2 process maps and identified potential failure modes, or barriers, to the successful completion of each step. Thirteen and 10 barriers were identified in the home and SNF process maps, respectively. Task force members created 5 subgroups, each developing solutions for a group of related barriers. The 5 areas of focus included (1) the OPAT electronic order set, (2) critical tasks to be performed before patient discharge, (3) patient education, (4) patient follow-up and laboratory monitoring, and (5) SNF communication. Interventions involved working with information technology to update the electronic order set, bridging communication and ensuring completion of critical tasks by creating an inpatient electronic discharge checklist, developing patient education resources, planning a central OPAT outpatient database within the electronic medical record, and creating a pharmacist on-call pager for SNFs. Conclusion The FMEA approach was helpful in identifying perceived barriers to successful transitions of care in patients discharged on OPAT and in developing targeted interventions. Healthcare organizations may reproduce this strategy when completing quality improvement planning for this high-risk process.

scholarly journals Outpatient parenteral antimicrobial therapy (OPAT) for aortic vascular graft infection; a five-year retrospective evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Niamh Allen ◽  
Mohamed Adam ◽  
Grace O’Regan ◽  
Aoife Seery ◽  
Cora McNally ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Vascular Graft ◽  
Hospital Admissions ◽  
Cohort Analysis ◽  
Graft Infection ◽  
Endovascular Aneurysm Repair ◽  
Vascular Graft Infection ◽  
Curative Surgery ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Long Term Treatment

Abstract Objectives An estimated 1% of endovascular aneurysm repair (EVAR) devices become infected, carrying a high mortality rate. Surgical explantation is recommended and prognosis is guarded. This retrospective cohort analysis focuses on the role of outpatient parenteral antimicrobial therapy (OPAT) in the management of aortic vascular graft infections following EVAR. Methods Patients who received OPAT for aortic graft infections (AGI) following EVAR from 2014 to 2018 inclusive were identified using the OPAT database. Clinical, microbiological and radiological data were collected. Survivors were followed up for a median of 36 months (range 25–60) after first presentation with infection. Outcomes were assessed. Results Eleven cases with 20 OPAT episodes were identified: 10/11 male, median age 76 (IQR 71–81). Median time to presentation was 7 months (range 0–81 months) after EVAR. OPAT lead to a 55% reduction in length of hospital stay. One patient had graft explantation; four others had temporising measures. Eight of 11 were alive a median of 36 months after presentation with infection, having had a median of 2 re-treatments on OPAT (range 1–3). Seven of the eight survivors were on continuous suppressive oral antimicrobials; three were also intermittently on intravenous antibiotics for flares of infection. Patient/ infection outcomes were cure (1/11), improved (7/11), failure (3/11). Conclusion AGI following EVAR usually presents in the first year after graft deployment. OPAT has an important peri-operative role in patients suitable for curative surgery. OPAT followed by oral suppressive antimicrobial therapy can be a feasible long-term treatment for non-curative management of AGI. Survival in our cohort was longer than expected, and OPAT was feasible despite the complexity of these infections. OPAT can avoid multiple and lengthy hospital admissions and maximise time at home and quality of life in this cohort with life-limiting infection.

scholarly journals Impact of a large-scale telemedicine network on emergency visits and hospital admissions during the coronavirus disease 2019 pandemic in Brazil: Data from the UNIMED-BH system

2020 ◽  
pp. 1357633X2096952
Author(s):  
Bruno R Nascimento ◽  
Luisa CC Brant ◽  
Ana Cristina T Castro ◽  
Luiz Eduardo V Froes ◽  
Antonio Luiz P Ribeiro ◽  
...  
Keyword(s):  
Large Scale ◽  
Hospital Admissions ◽  
Diagnosis Related Groups ◽  
Mobile App ◽  
Telemedicine System ◽  
Phone Calls ◽  
Emergency Ambulance ◽  
Surge Control ◽  
Ed Visits ◽  
The Impact

Introduction Triage by on-demand telemedicine is a strategy for healthcare surge control in the COVID-19 pandemic. We aimed to assess the impact of a large-scale COVID-19 telemedicine system on emergency department (ED) visits and all-cause and cardiovascular hospital admissions in Brazil. Methods From March 18-May 18, 2020 we evaluated the database of a cooperative private health insurance, with 1.28 million clients. The COVID-19 telemedicine system consisted of: a) mobile app, which redirects to teleconsultations if indicated; b) telemonitoring system, with regular phone calls to suspected/confirmed COVID-19 cases to monitor progression; c) emergency ambulance system (EAS), with internet phone triage and counselling. ED visits and hospital admissions were recorded, with diagnoses assessed by the Diagnosis Related Groups method. COVID-19 diagnosis and deaths were identified from the patients’ registries, and outcomes assessed until June 1st. Results In 60 days, 24,354 patients accessed one of the telemedicine systems. The most frequently utilized was telemonitoring (16,717, 69%), followed by teleconsultation (13,357, 55%) and EAS (687, 3%). The rates of ED and hospital admissions were: telemonitoring 19.7% (3,296) and 4.7% (782); teleconsultation 17.3% (2,313) and 2.4% (318) and EAS: 55.9% (384) and 56.5% (388) patients. At total 4.1% (1,010) had hospital admissions, 36% (363) with respiratory diseases (44 requiring mechanical ventilation) and 4.4% (44) with cardiovascular diagnoses. Overall, 277 (1.1%) patients had confirmed COVID-19 diagnosis, and 160 (0.7%) died, 9 with COVID-19. Conclusion Telemedicine resulted in low rates of ED visits and hospital admissions, suggesting positive impacts on healthcare utilization. Cardiovascular admissions were remarkably rare.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

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