scholarly journals P64 Implementation of a paediatric outpatient parenteral antibiotic therapy (p-OPAT) service at a specialist children’s hospital

2020 ◽  
Vol 105 (9) ◽  
pp. e39.2-e40
Author(s):  
Hannah Porter ◽  
Kate Stock
Keyword(s):  
Data Collection ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
List Type ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Paediatric Outpatient ◽  
Bed Days ◽  
One Year

AimThe aim of this project is to optimise patient care, enhance patient experience, improve antimicrobial stewardship and assist patient flow through the hospital.MethodData collection was conducted one day a week over five consecutive weeks. All eligible wards were visited. Patient medication charts were inspected to see if intravenous antimicrobials were prescribed and a patient - specific data collection form was then completed. All the patients that met the eligibility criteria to be put forward for OPAT referral were then considered from a clinical perspective by a paediatric consultant as to their suitability for OPAT or IVOST and discharge. If the patient was deemed suitable for an OPAT discharge or IVOST and discharge a decision was made as to what antimicrobials they would theoretically have been on when discharged home. The number of potential bed days saved was calculated as the number of days between the patients review by the consultant (ie the day of data collection) and the date of their discharge prescription from that episode of care.The following was examinedpercentage of patients with identified pathogenspercentage of patients that had received input from the ID teampercentage of patients that had received input from microbiologythe prevalence of antimicrobials prescribedthe location of the patient’s home residencepatient/parent willingness to go home on OPAT.The data for patient numbers and bed day savings was then extrapolated to 52 weeks in order to be indicative of one year.ResultsOver the five days, 66 patients were identified that met the exclusion criteria to be referred for OPAT or IVOST. After clinical consideration the consultant deemed 4 patients to be suitable for OPAT and 19 for IVOST and discharge which generated a potential bed day saving of 38 bed days. This was comprised of 17 days through providing IVAs via OPAT and 21 days from timelier IVOST and discharge of patients. Extrapolated to be representative of one year, this would be a bed saving to the Trust of 1, 976 bed days.ConclusionThe potential has been identified for the hospital to make considerable bed day savings through the investment in an extended antimicrobial stewardship programme and establishment of a paediatric OPAT service. A business case has been submitted to the hospital board for consideration, with the hope that the service will be funded for a six month probationary period in order to assess its impact over the winter months, when demand for beds and pressures on PICU and theatres are highest.ReferencesPatel S, et al. 2015. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement. Journal of Antimicrobial Chemotherapy2015;702:360–373.Carter B, et al. Delivery, setting and outcomes of paediatric outpatient parenteral antimicrobial therapy (OPAT): a scoping review. BMJ Open, 2018;8:e021603.Hodgson KA, et al. The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Archives of Disease in Childhood, 2016:10:886–893.Knackstedt ED, et al. Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship. Infection Control & Hospital „Epidemiology 2015:36:222–224.

scholarly journals Vancomycin or Daptomycin for Outpatient Parenteral Antibiotic Therapy: Does It Make a Difference in Patient Satisfaction?

2021 ◽  
Vol 8 (8) ◽  
Author(s):  
Katherine H Wu ◽  
George Sakoulas ◽  
Matthew Geriak
Keyword(s):  
Patient Satisfaction ◽  
Antibiotic Therapy ◽  
Antimicrobial Therapy ◽  
Telephone Survey ◽  
Satisfaction Score ◽  
Parenteral Antibiotic ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Outpatient Parenteral Antibiotic Therapy ◽  
Interference Score

Abstract A 5-question telephone survey was administered to compare satisfaction between patients receiving vancomycin vs daptomycin outpatient parenteral antimicrobial therapy (OPAT). Twenty-seven patients completed the survey (40%). Vancomycin had higher daily interference score than daptomycin (P = .03). All patients receiving daptomycin reported a satisfaction score ≥8/10, as compared to 67% of patients who received vancomycin (P < .03). OPAT antibiotics with less cumbersome administration regimens may translate into higher patient satisfaction and quicker return to life normalcy.

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 P32 An audit to assess the suitability of patients at a tertiary/quaternary paediatric hospital to switch from intravenous (IV) to oral (PO) antimicrobial therapy

2020 ◽  
Vol 105 (9) ◽  
pp. e23.1-e23
Author(s):  
Orlagh McGarrity ◽  
Aliya Pabani
Keyword(s):  
High Risk ◽  
Antimicrobial Resistance ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Blood Cultures ◽  
Antimicrobial Use ◽  
List Type ◽  
Paediatric Hospital ◽  
Oral Agents

Introduction, Aims and ObjectivesIn 2011 the Start Smart then Focus campaign was launched by Public Health England (PHE) to combat antimicrobial resistance.1 The ‘focus’ element refers to the antimicrobial review at 48–72 hours, when a decision and documentation regarding infection management should be made. [OM1] At this tertiary/quaternary paediatric hospital we treat, immunocompromised, high risk patients. In a recent audit it was identified that 80% of antimicrobial use is IV, this may be due to several factors including good central access, centrally prepared IV therapy and oral agents being challenging to administer to children. The aim of the audit was to assess if patient have a blood culture prior to starting therapy, have a senior review at 48–72 hours, and thirdly if our high proportion of intravenous antimicrobial use is justified.MethodElectronic prescribing data from JAC was collected retrospectively over an 8 day period. IV antimicrobials for which there is a suitable oral alternative, this was defined as >80% bioavailability, were included. Patients were excluded in the ICU, cancer and transplant setting, those with absorption issues and with a high risk infection, such as endocarditis or bacteraemia. Patient were assessed against a set criteria to determine if they were eligible to switch from IV to PO therapy; afebrile, stable blood pressure, heart rate <90/min, respiratory rate < 20/min for 24 hours. Reducing CRP, reducing white cell count, blood cultures negative or sensitive to an antibiotic that can be given orally.Results100% of patients (11) had a blood cultures taken within 72 hours of starting therapy55% of patients had a positive blood culture82% of patients had a senior review at 48–72 hours46% of patients were eligible to switch from IV to PO therapy at 72 hours33% of eligible patients were switched from IV to PO therapy at 72 hoursConclusion and RecommendationsThis audit had a low sample size due to the complexity of the inclusion and exclusion criteria, and the difficulty in reviewing patient parameters on many different hospital interfaces. It is known that each patient is reviewed at least 24 hourly on most wards and therefore there is a need for improved documentation of prescribing decisions. Implementation of an IV to oral switch guideline is recommended to support prescribing decisions and educate and reassure clinicians on the bioavailability and benefits of PO antimicrobial therapy where appropriate. Having recently changed electronic patient management systems strategies to explore include hard stops on IV antimicrobial therapies, however this will require much consideration. Education of pharmacist and nurses is required to raise awareness about antimicrobial resistance and the benefits of IV to PO switches, despite the ease of this therapy at out Trust. This will promote a culture in which all healthcare professionals are active antimicrobial guardians, leading to better patient outcomes, less service pressures, and long term financial benefit.ReferenceGOV.UK. 2019. Antimicrobial stewardship: Start smart - then focus. [ONLINE]Available at: https://www.gov.uk/government/publications/antimicrobial-stewardship-start-smart-then-focus [Accessed 3 July 2019]

scholarly journals MP52: Effectiveness of an outpatient parenteral antibiotic therapy clinic for adults with non-purulent cellulitis

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S61-S61
Author(s):  
A. Mattice ◽  
R. Yip ◽  
D. Eagles ◽  
H. Rosenberg ◽  
K. Suh ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antibiotic Therapy ◽  
Hospital Admission ◽  
Treatment Failure ◽  
Post Intervention ◽  
Parenteral Antibiotic ◽  
Monthly Data ◽  
Outpatient Parenteral Antibiotic Therapy ◽  
Ed Visits ◽  
One Year

Introduction: Emergency department (ED) patients with cellulitis that are treated with intravenous (IV) antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary objective of this study was to determine whether the implementation of an OPAT clinic results in decreased hospitalization and return ED visits for patients treated with IV antibiotics. Methods: We conducted a before-after implementation study involving adults (age >=18 years) that presented to two tertiary care EDs with cellulitis and were treated with IV antibiotics. The intervention was referral to an infectious disease physician within one week of the index ED visit at the newly created OPAT clinic. The primary outcomes were hospital admission and return ED visits within 14 days. Secondary outcomes were treatment failure (admission after 48 hours of OPAT) and adverse events (e.g. vomiting, diarrhea). We conducted an interrupted time series analysis from January to December both pre-intervention (2013) and post-intervention (2015), with 24 monthly data points. The year of clinic implementation (2014) was considered a transition period. A segmented non-linear regression autoregressive error model was used to aggregate the monthly data to evaluate the effectiveness of the intervention. Results: A total of 1,666 patients met inclusion criteria: 858 pre-intervention (mean age 59 years, 53.1% male) and 808 post-intervention (mean age 62 years, 54.5% male). Hospitalization rates were not significantly higher one year after clinic implementation (p = 0.53) although there was a non-statistically significant gradual increase of 0.8% per month (95%CI -0.3% to 1.9%). One year after introduction of the OPAT clinic, return ED visits were significantly lower (change in intercept -24.4%, 95%CI -34.2% to -14.6%; p < 0.001), followed by an additional drop of 1.4% per month (95%CI -2.1% to -0.6%; p = 0.002). By the end of the study, return visits were 40.7% lower (95%CI 25.6% to 55.9%) than if the intervention had not been introduced. Treatment failure rates were <2% and adverse events were <5% in both groups. Conclusion: Implementation of an OPAT clinic significantly reduced return ED visits for cellulitis, which is critically important given the current ED overcrowding crisis. There was no significant change in hospital admission rates. There were low rates of treatment failures and adverse events. An OPAT clinic should be considered to reduce ED crowding while maintaining safe patient care.

scholarly journals Impact of Antimicrobial Stewardship Review for Pediatric Outpatient Parenteral Antimicrobial Therapy (OPAT)

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Jared Olson ◽  
Chris Stockmann ◽  
Emily Thorell ◽  
Elizabeth Knackstedt ◽  
Andrew Pavia ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy

scholarly journals 2082. Evaluation of Outpatient Parenteral Antimicrobial Therapy (OPAT) Processes and Outcomes Among Patients Within an Integrated Health System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S702-S702
Author(s):  
Brittany Brown ◽  
Thomas J Dilworth ◽  
Margaret Cook ◽  
Charles F Brummitt
Keyword(s):  
Antibiotic Therapy ◽  
Health System ◽  
Antimicrobial Therapy ◽  
High Volume ◽  
Treatment Level ◽  
Once Daily ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Patient Demographics ◽  
Level Data ◽  
Access Complications

Abstract Background Successful management of outpatient parenteral antimicrobial therapy (OPAT) optimizes outcomes and reduces cost. We examined (i) local OPAT processes and outcomes, (ii) whether OPAT constraints favoring once daily antibiotics promoted suboptimal therapeutic choices, and (iii) whether these data could drive OPAT improvements. Methods Patients ≥ 18 years of age who received > 48 hours of OPAT at five infusion centers within a single health-system from January 1, 2018 to March 1, 2018 were eligible for review. The following patient- and treatment-level data were collected: age, gender, drug allergies, laboratory studies and frequency, OPAT indication, infection source, pathogen(s), antibiotic sensitivities, antibiotic therapy and duration, electronic order set used, prescriber specialty, evidence of failed prior oral or intravenous (IV) therapy and IV access type. The primary outcome was OPAT success: the clinical resolution of the infection without relapse within 30 days of antibiotic therapy completion. Secondary outcomes included change in antibiotic therapy due to lack of clinical improvement, adverse drug reactions and IV access complications. A sub-analysis of patients who received daptomycin and/or ertapenem was also performed. OPAT practice was compared with 2018 Infectious Diseases Society of America OPAT guidelines (Norris et al. Clin Infect Dis. 2019;68(1):e1-e35). Results A total of 108 patients were evaluated. Patient demographics, treatment and outcomes are shown in Table 1. The most common OPAT indications were bone/joint, bacteremia and skin infection. Third-generation cephalosporins, carbapenems and daptomycin were most commonly prescribed. In 34.3% and 24.2% of daptomycin and ertapenem cases, respectively, β-lactam therapy could have been utilized. Assessment of prior failed antibiotic therapy, patient allergies and pathogen-site pairing found 28.7% of patients were eligible for oral therapy upon OPAT initiation. Conclusion Several components of our local OPAT aligned with current guidelines. Initial OPAT patient selection may benefit from added scrutiny. Given the high volume of once daily antibiotics administered for convenience there is an internal opportunity to facilitate multi-daily infusions. Disclosures All authors: No reported disclosures.

Outpatient Parenteral Antimicrobial Therapy in Pediatrics: An Opportunity to Expand Antimicrobial Stewardship

2014 ◽  
Vol 36 (2) ◽  
pp. 222-224 ◽  
Author(s):  
Elizabeth D. Knackstedt ◽  
Chris Stockmann ◽  
Carly R. Davis ◽  
Emily A. Thorell ◽  
Andrew T. Pavia ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Infect Control Hosp ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Children's Hospital ◽  
Large Tertiary Care ◽  
Children’S Hospital

We reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether outpatient parenteral antimicrobial therapy was modifiable or unnecessary at a large tertiary care children’s hospital. At least one modification definitely or possibly would have been recommended for 78% of episodes. For more than 40% of episodes, outpatient parenteral antimicrobial therapy was potentially not indicated.Infect Control Hosp Epidemiol 2014;00(0):1–3

scholarly journals Paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT): An e-survey of the experiences of parents and clinicians

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249514
Author(s):  
Bernie Carter ◽  
Debra Fisher-Smith ◽  
David Porter ◽  
Steven Lane ◽  
Matthew Peak ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Tertiary Hospital ◽  
Parental Satisfaction ◽  
Hospital Data ◽  
Family Routines ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Open Questions ◽  
Home Based ◽  
Parents And Children ◽  
Paediatric Outpatient

Background Little evidence exists about parental satisfaction and their influence on referral to paediatric Outpatient Parenteral Antimicrobial Therapy (OPAT). Aim This study aimed to examine the experiences of parents, children and clinicians of OPAT at a large tertiary children’s hospital. Method A prospective e-survey, using closed and open questions, of parents (n = 33) of 33 children who had received OPAT (3 children completed a survey), and clinicians (n = 31) involved in OPAT at a tertiary hospital. Data were collected September 2016 to July 2018. Results Data were analysed using simple descriptive statistics. The results show that OPAT offered benefits (less stress, re-establishment of family life) compared to hospital-based treatment for parents and children, although some were anxious. Clinicians’ referral judgements were based on child, home, and clinical factors. Some clinicians found the process of referral complex. Conclusion Most parents and children were satisfied with the OPAT service and preferred the option of home-based treatment as it promoted the child’s comfort and recovery and supported family routines.

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