scholarly journals 755. Outpatient Parenteral Antimicrobial Therapy Program Evaluation within a Large Veterans Affairs Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S337-S337
Author(s):  
Michael Kent ◽  
Marcus Kouma ◽  
Jodlowski Tomasz ◽  
James B Cutrell ◽  
James B Cutrell
Keyword(s):  
Antimicrobial Therapy ◽  
Geographic Region ◽  
Veterans Affairs ◽  
Third Party ◽  
North Texas ◽  
Improvement Project ◽  
Telephone Consultation ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Prosthetic Joint Infections ◽  
Va Hospitals

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) allows safe delivery of IV antibiotics in ambulatory settings to facilitate hospital discharge. Within the Veterans Affairs (VA) system, OPAT programs face the unique challenges of large geographic coverage areas and referrals for veterans from non-VA hospitals. Methods Patients enrolled in the VA North Texas Health Care System OPAT program during fiscal years 2016 to 2018 had data collected on demographics, comorbidities, OPAT indications, antimicrobials used, pharmacist interventions, and complications during therapy. Data were collected from retrospective chart review as a quality improvement project. All enrolled OPAT patients required either an inpatient infectious disease (ID) consult or, for patients from non-VA facilities, required medical records review and telephone consultation with approval by a VA ID clinician. A third-party infusion company provided all medications and line care. Weekly laboratory monitoring and follow-up telephone visits were conducted by ID-trained pharmacists. Results During the evaluation period, 485 unique OPAT encounters (425 patients) were completed, with 164 patients (33%) directly admitted to OPAT upon referral from non-VA hospitals. Most common OPAT indications were osteomyelitis/diabetic foot infections (40.4%), bacteremia (17.3%), prosthetic joint infections/septic arthritis (12.4%), and urinary/intrabdominal infections (11.7%). Following standardization of pharmacist documentation, the volume and consistency of documented notes and interventions increased. Readmission rates while on therapy were similar, ranging from 13.4% to 13.7% each year. Patient demographics and OPAT outcomes demonstrated steady growth in the program (Table 1) with low rates of complications on therapy (Table 2). The program served patients in 35 counties and 158 zip codes across a broad geographic region in North Texas and southern Oklahoma (Figure 1). The most commonly used antibiotics are shown in Figure 2. Conclusion Our program has demonstrated the ability to safely and effectively provide OPAT across a large geographic region from a central location. ID-trained clinical pharmacists are critical to the care coordination and safety monitoring of OPAT in this unique setting. Disclosures All authors: No reported disclosures.

scholarly journals 613. Clinical Outcomes Following Dalbavancin Administration during Outpatient Parenteral Antimicrobial Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S410-S410
Author(s):  
Jessica Tuan ◽  
Jehanzeb Kayani ◽  
Ann Fisher ◽  
Brian Kotansky ◽  
Louise Dembry ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Clinical Cure ◽  
Veterans Affairs ◽  
Short Term ◽  
Gram Positive ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
All Cause Mortality ◽  
Antibiotic Duration ◽  
Staphylococcus Spp ◽  
Median Hospital

Abstract Background Dalbavancin, a lipoglycopeptide with prolonged half-life targeting Gram-positive organisms, is approved for treatment of acute bacterial skin and soft tissue infection. It reduces hospital duration in patients with barriers to short-term rehabilitation or outpatient parenteral antimicrobial therapy (OPAT). Increasing evidence supports the off-label use of dalbavancin to treat other types of infection. We conducted a quality improvement study to evaluate outcomes following dalbavancin administration. Methods We performed a cohort study of recipients of ≥1 dose of dalbavancin from 1/31/2016-1/31/2021 at the Veterans Affairs Connecticut Healthcare System. Demographic, comorbidity, microbiological, antibiotic duration prior to dalbavancin, indication for dalbavancin, and type of infection data were collected. Outcomes included 1) lab abnormalities: hepatotoxicity within 2 weeks of dalbavancin; 2) clinical cure: resolution of symptoms of infection within 90 days; 3) all-cause readmission within 90 days; and 4) all-cause mortality within 90 days. Results 42 patients met criteria. Median age was 69 years (range, 32-91), 100% were male, 55% (n=23) had diabetes, 31% (n=13) had liver disease, 36% (n=15) had other immunosuppressive conditions, and 12% (n=5) had substance use disorder (SUD). All received their first dose as inpatients. Median hospital duration was 8 days (range, 1-32). 4 (10%) required critical care. Median antibiotic duration prior to dalbavancin was 7 days (range, 1-42). Indications included ineligibility for OPAT (n=21, 50%), pharmacologic reasons (n=10, 24%), ineligibility for peripherally inserted central catheter (n=6, 14%), or SUD (n=5, 12%). Common microorganisms were Staphylococcus spp. (n=22, 52%), polymicrobial (n=13, 31%), and Corynebacterium spp. (n=10, 24%). 93% (n=39) had clinical cure of infection; readmissions and mortality were rare (Table 1). Conclusion Dalbavancin was associated with clinical cure for diverse infections with low rates of adverse events, readmission and mortality in patients ineligible for traditional OPAT. Although confirmatory data are needed from larger studies, dalbavancin appears to be a versatile therapeutic agent for Gram-positive infections. Disclosures All Authors: No reported disclosures

scholarly journals 1297Evaluation of Outpatient Parenteral Antimicrobial Therapy (OPAT) at a Veterans Affairs (VA) Hospital

2014 ◽  
Vol 1 (suppl_1) ◽  
pp. S51-S51
Author(s):  
Emily Sydnor ◽  
Brian Kendall ◽  
Patricia Orlando ◽  
Christian Perez ◽  
Matthew Samore ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Veterans Affairs ◽  
Outpatient Parenteral Antimicrobial Therapy

scholarly journals 54. Effectiveness of a Venous Catheter Stewardship Intervention Targeting Parenteral Antimicrobial Therapy at Hospital Discharge

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S49-S49
Author(s):  
Vasilios Athans ◽  
Keith W Hamilton ◽  
Anne Norris ◽  
Lauren Dutcher ◽  
Kathleen Degnan ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Venous Catheter ◽  
Third Party ◽  
Audit And Feedback ◽  
High Yield ◽  
Prospective Audit ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Academic Medical ◽  
Prospective Audit And Feedback

Abstract Background Peripherally inserted central catheters (PICCs) and midlines are often used in hospitalized patients who require outpatient parenteral antimicrobial therapy (OPAT) upon discharge. PICCs/midlines offer ease of insertion but still carry the risks of venous thrombosis, phlebitis, and catheter-associated infection. We report the results of a prospective audit and feedback (PAF) intervention targeting the placement of PICCs/midlines for OPAT at our institution. Methods We prospectively identified a cohort of patients identified by a real-time PICC/midline alert from 5/20/2019 through 5/29/2020 at two large academic medical centers. Alerts were generated by a third-party interface with the electronic health record and identified new line orders with an antimicrobial indication selected. Patients without infectious diseases (ID) consult underwent PAF by the antimicrobial stewardship team. Descriptive statistics were used to characterize patients, interventions, and outcomes. Results During the study period, 1267 PICC/midline alerts were identified. Most were excluded due to ID consult (85.4%). After exclusions, 113 alerts underwent full review. Median patient age was 64 years with female predominance (54.2%). Reviewable alerts most commonly originated from Pulmonary (36.5%) and Hospitalist (26.0%) services. The most frequent antimicrobial indications were pneumonia (37.5%) and bloodstream infection (28.1%), and the most frequently ordered antimicrobials were cefepime (27.1%) and piperacillin-tazobactam (17.7%). Median time from line order to insertion was 22 hours and from line insertion to discharge was 48 hours. Of 113 alerts reviewed by the stewardship team, 26 (23.0%) resulted in a recommendation to avoid line placement and 45 (39.8%) resulted in at least one specific stewardship recommendation (Table 1). Recommendations were fully or partially accepted in 58.3% of instances. TABLE 1. Interventions Resulting from Prospective Venous Catheter Stewardship Conclusion Prospective audit of PICC/midline orders for OPAT identified a line-sparing opportunity in nearly 1 in 4 cases. Where line avoidance was not possible, other opportunities for antimicrobial optimization were common. This high-yield intervention should be considered for institutions that do not mandate infectious diseases consult for all OPAT discharges. Disclosures All Authors: No reported disclosures

Evaluation of Outpatient Parenteral Antimicrobial Therapy at a Veterans Affairs Hospital

2015 ◽  
Vol 36 (9) ◽  
pp. 1103-1105 ◽  
Author(s):  
Emily Sydnor Spivak ◽  
Brian Kendall ◽  
Patricia Orlando ◽  
Christian Perez ◽  
Marina De Amorim ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Veterans Affairs ◽  
Infect Control Hosp ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Infectious Diseases Consultation

We reviewed outpatient parenteral antimicrobial therapy at a Veterans Affairs Medical Center to identify opportunities for antimicrobial stewardship intervention. A definite or possible modification would have been recommended in 60% of courses. Forty-one percent of outpatient parenteral antimicrobial therapy courses were potentially avoidable, including 22% involving infectious diseases consultation.Infect. Control Hosp. Epidemiol. 2015;36(9):1103–1105

scholarly journals Utilizing a Post-discharge Telephone Call in Outpatient Parenteral Antimicrobial Therapy (OPAT): Findings from a Quality Improvement Project

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S333 ◽  
Author(s):  
Kimberly Felder ◽  
Louise Vaz ◽  
Penelope Barnes ◽  
Cara Varley
Keyword(s):  
Quality Improvement ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Hospital Readmissions ◽  
Completion Rate ◽  
Transitions Of Care ◽  
Post Discharge ◽  
Improvement Project ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Arm Pain

Abstract Background Transitions of care from hospitals to outpatient settings, especially for patients requiring outpatient parenteral antimicrobial therapy (OPAT) are complex. OPAT complications, such as adverse antimicrobial reactions, vascular access problems, and hospital readmissions are common. Data from transitions of care literature suggest that post-discharge telephone calls (TCs) may significantly decrease re-hospitalization but no studies have assessed the utility of post-discharge TCs as an OPAT program quality improvement process. Methods Adult OPAT patients discharged from our hospital between April 1, 2015 and May 31, 2016 were queried for post-discharge concerns. TCs to patients or their caregivers were administered by trained medical assistants within the Department of Infectious Diseases using a standardized script and documented in the electronic medical record (EMR). Feasibility was assessed using call completion rate. The type and frequency of reported issues were analyzed by retrospective chart review. Results 636 of 689 eligible adult OPAT patients or their caregivers received a TC with responses to scripted questions documented in the EMR (92% completion rate). 302 patients (47%) reported 319 issues, including 293 (92%) relevant to OPAT. Antimicrobial issues included diarrhea/stool changes (58; 9%); nausea/vomiting (27; 4%); and missed antimicrobial doses (22; 3%). Vascular access issues included line patency concerns (21; 3%); vascular access dressing problems (17; 2.6%) and arm pain/swelling (6; 1%). OPAT vendor issues included delays in lab or line care services (23; 4%) and OPAT orders reported as lost/not received (21; 3%). Other ID-related issues included fevers/chills/sweats (27; 4%), wound concerns (16; 2.5%), and pain (15; 2.5%). Conclusion Adding a post-discharge TC to an OPAT program was feasible and resulted in frequent and early identification of significant OPAT patient and caregiver concerns. Findings suggest potential high-yield topics for process improvement, as well as anticipatory guidance and patient education in OPAT. Further evaluation and analysis of optimal hospital discharge processes and care coordination in OPAT, as well as their impact on post-discharge adverse events, is needed. 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 623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Yasir Hamad ◽  
Jaspur Min ◽  
Yvonne Burnett
Keyword(s):  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Clinic Visit ◽  
Hospital Length Of Stay ◽  
Uninsured Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Joint Infections ◽  
Insured Patients ◽  
Hospital Days

Abstract Background Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care. Methods Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients. Results Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000. Conclusion S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources. Table Disclosures All Authors: No reported disclosures

Developing an OPAT service that meets the ever-changing needs of patients

2021 ◽  
Vol 30 (2) ◽  
pp. S12-S14
Author(s):  
Elizabeth Wilson
Keyword(s):  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy

Elizabeth Wilson, Lead Nurse, Outpatient Parenteral Antimicrobial Therapy, Manchester University NHS Foundation Trust ( [email protected] ), BJN Awards 2020 Vascular Access Nurse of the Year runner-up

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