A low-cost intervention to promote immediate skin-to-skin contact and improve temperature regulation in Northern Uganda

Background Uninterrupted skin-to-skin contact between mothers and newborns during the first hour after birth has been reported to be 2% in Uganda. Aims To investigate if a low-cost intervention targeting the behaviors of hospital staff would increase skin-to-skin contact and to investigate whether skin-to-skin contact stabilised temperature in the newborn. Methods The study had a quasi-experimental, before and after design. The sample included 110 in the pre-intervention group, and 93 in the post-intervention group. Data collection included observations of skin-to-skin contact and temperature measurements. Data were also collected from medical records and interviews. Findings No infants had skin-to-skin contact before the intervention, whereas the proportion was 54.8% after the intervention. Infants who received skin-to-skin contact (n=51) and infants who did not receive skin-to-skin contact (n=146) increased in temperature; however, infants who received skin-to-skin contact were significantly warmer after 5 minutes and remained so at 60 minutes. Conclusions The intervention increased the practice of skin-to-skin contact, which was found to be safe in regard to temperature stabilisation.

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The Effectiveness of the Use of Nurse Safety Booklet on Nurse Knowledge in Ergonomic Injury Prevention in BIMA Hospital

International Journal of Studies in Nursing ◽

10.20849/ijsn.v4i2.578 ◽

2019 ◽

Vol 4 (2) ◽

pp. 108

Author(s):

A. Haris ◽

Abdul Haris

Keyword(s):

Health Services ◽

Intervention Group ◽

Hospital Staff ◽

Control Group ◽

P Value ◽

Research Subjects ◽

Post Intervention ◽

Quasi Experimental ◽

The Difference ◽

Nurse Knowledge

Safety has become a global issue in various sectors, including the health services sector. The hospital is one of the health service organizations that is guided to continuously improve quality by building safer and safer health services so as to get customer loyalty. Hospital staff is a major component of quality management in one of the indicators in evaluating hospital accreditation. This research uses a quasi-experimental research design pre and posttest with control group. Quasi experiment research is a study that tests an intervention in a group of research subjects and then measures the results of the intervention. Samples in this study are all nurses who are in the room of the General Hospital, Surgery and ICU Bima Hospital, which are 50 people. The results showed the results of different tests using paired t-test p value = 0.000 which can be concluded that there are differences between the intervention group and the control group, seen from the value of the difference in the intervention group is greater than the difference in the control group can be interpreted as education using more booklets affect the increase in nurse knowledge. The conclusion in this study was that there were significant differences in nurses' knowledge after being given education using pre and post intervention booklets between the intervention and control groups (p = 0.000).

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46. Antimicrobial Stewardship’s Selective Antibiotic Suppression Does Not Lead to Adverse Outcomes in Neutropenic Patients with Gram-Negative Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.091 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S46-S46

Author(s):

Anna Witt ◽

Mason G Harper ◽

Juan Carlos Rico Crescencio ◽

Ryan K Dare ◽

Mary Burgess

Keyword(s):

Intervention Group ◽

Adverse Outcomes ◽

Post Intervention ◽

Gram Negative ◽

Narrow Spectrum ◽

Stewardship Program ◽

Significant Difference ◽

Before And After ◽

Gram Negative Bacteremia ◽

Post Intervention Group

Abstract Background An antimicrobial stewardship program (ASP) strategy to minimize the use of overly broad antimicrobials is to suppress specific antimicrobial susceptibility results when isolates are sensitive to narrow antibiotics. There is limited data on possible adverse outcomes of this method. Patients with febrile neutropenia (FN) and gram-negative bacteremia (GNB) whose culture is sensitive to non-pseudomonal antibiotics still require broader pseudomonal coverage to treat the syndrome of FN. We evaluated if ASP suppression of anti-pseudomonal antibiotics adversely affects patients with FN and GNB. Methods In February 2018, our institution’s ASP began suppressing cefepime and meropenem susceptibility results from E. coli, Klebsiella spp, and Proteus spp when sensitive to cefepime (MIC ≤ 2), ceftriaxone and ceftazidime. We performed a retrospective analysis of patients with FN and GNB from 2016 – 2020 to evaluate the appropriateness of antibiotic regimens before and after the ASP intervention. Antibiotic regimens were deemed inappropriate if the patient was de-escalated to a narrow-spectrum, non-pseudomonal agent while neutropenic. Of 338 inpatient encounters identified with any bacteremia and FN, 49 were due to non-Pseudomonas, non-ESBL GNB, 20 before and 29 after the intervention. Sixteen of the 29 post-intervention patients were excluded, as their isolates did not meet suppression criteria. This resulted in a total of 13 patients in the post-intervention group. Results After culture susceptibility reports were released, 3 out of 20 patients in the pre-intervention group (15%) and 4 out of 13 patients in the post-intervention group (30.8%) were inappropriately tailored to narrow-spectrum antibiotics (p=0.39). There was no significant difference in 30-day mortality, 10.0% pre- and 0% post-intervention (p=0.50), or amount of meropenem prescribed, 45% pre- and 38.5% post-intervention (p=0.74). Conclusion These data show no significant difference in inappropriate antibiotic regimens prescribed for patients with FN and GNB after ASP antibiotic suppression was implemented. 30-day mortality was also not affected. The ASP intervention did not decrease meropenem prescriptions in this patient group, which may be appropriate. Larger studies are needed to verify these findings. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support) Mary Burgess, MD, Pfizer Inc (Grant/Research Support)

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Efek Spiritual Emotional Freedom Techniqueterhadap Cemas dan Depresi, Sindrom Koroner Akut

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v1i1.51 ◽

1970 ◽

Vol 1 (1) ◽

Author(s):

Derison Marsinova Bakara ◽

Kusman Ibrahim ◽

Aat Sriati

Keyword(s):

Group Intervention ◽

Intervention Group ◽

Sampling Technique ◽

Control Group ◽

Return Rates ◽

Coronary Syndrome ◽

Group Data ◽

Before And After ◽

Quasi Experimental ◽

And Control

Sindrom koroner akut (SKA) merupakan penyakit jantung penyebab kematian. Gejala depresi, kecemasan, dan stres meningkat pada pasien SKA. Gejala ini dapat memengaruhi proses pengobatan dan penyembuhan serta menimbulkan komplikasi. Penelitian ini bertujuan untuk mengidentifikasi pengaruh SEFT terhadap penurunan gejala depresi, kecemasan, dan stres pada pasien SKA yang dirawat di ruang rawat intensif jantung. Rancangan penelitian menggunakan quasi eksperimen, teknik pengambilan sampel dengan consecutive sampling,sebanyak 42 orang. Penetapan jumlah responsden untuk kontrol dan kelompok intervensi menggunakan number ramdom trial, sehingga ditetapkan kelompok intervensi berjumlah 19 responsden dan untuk kelompok kontrol berjumlah 23 responsden. Kelompok intervensi dan kelompok kontrol diukur tingkat depresi, kecemasan, dan stres mengunakan kuesioner The Depression Anxiety Stres Scales 21(DASS 21) kemudian pada kelompok intervensi diberikan intervensi SEFT satu kali selama 15 menit dan diukur kembali tingkat depresi, kecemasan, dan stres pada kelompok intervensi dan kelompok kontrol. Data dianalisis dengan Wilcoxon dan Mann Whitney. Hasil menunjukkan perbedaan yang bermakna antara tingkat depresi, kecemasan, dan stres sebelum dan sesudah intervensi SEFT antara kelompok intervensi dan kelompok kontrol (p<0.05). Intervensi SEFT membantu menurunkan depresi, kecemasan, dan stres pada pasien SKA.Kata kunci:Depresi, intervensi SEFT, kecemasan, stres AbstractAcute coronary syndrome (ACS) is a cause of heart disease deaths. Symptoms of depressi on anxiety, and stres is increased in patients with ACS. These symptoms may affect treatment and healing processand cause complications. This study aims to determine the effect of intervention Spiritual Emotional Freedom Technique (SEFT) to decrease depression, anxiety, and stres in patients with ACS who were treated in the cardiac intensive care unit. The research design was quasi-experimental, and using consequtive sampling as sampling technique, 42 responsdents were divided into intervention and control groups. Determination the number of responsdents for the control and intervention groups using a number ramdom trial, 19 responsdents intervention group and 23 responsdents the control group. Intervention group and control group measure levels of depression, anxiety, and stres using questionnaires The Depression Anxiety Stres Scales 21 (DASS 21) later in the intervention group was given SEFT intervention once for 15 minutes and measured return rates of depression, anxiety, and stres in the intervention group and the control group. Data were analyzed with the Wilcoxon and Mann Whitney. Results show significant differences between levels of depression, anxiety, and stres before and after the intervention SEFT between the intervention group and the control group (p<0.05). SEFT interventions help reduce depression, anxiety, and stres in patients with ACS. Limitations of this study is the difficulty in controlling the characteristics of the responsdents as a confounding variable. This research benefits that SEFT interventions can be used to reduce depression, anxiety, and stres in patients with ACS, and can be consider as one intervention.Key words: Anxiety, depression, stres, SEFT Intervention

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The impact of an innovative pharmacist-led inpatient opioid de-escalation intervention in post-operative orthopedic patients

Journal of Opioid Management ◽

10.5055/jom.2020.0565 ◽

2020 ◽

Vol 16 (3) ◽

pp. 167-176

Author(s):

Thuy Bui, BPharm ◽

Richard Grygiel, MPharm ◽

Alex Konstantatos, MB BS (Hons), FANZCA, Dip Obs, MRCA ◽

Nick Christelis ◽

Susan Liew, MB BS (Hons), FRACS ◽

...

Keyword(s):

Pain Intensity ◽

Intervention Group ◽

Public Health Problem ◽

Prescription Opioid ◽

Opioid Use ◽

Post Intervention ◽

Before And After ◽

Orthopedic Patients ◽

The Impact ◽

Post Intervention Group

Objective: Many patients are discharged from hospital after surgery with excessive doses of opioid, and prescription opioid addiction has become a serious public health problem. Inpatient opioid de-escalation performed by clinical pharmacists may assist in reducing opioids before discharge. We aimed to evaluate whether clinical pharmacist-led opioid de-escalation for inpatients after orthopedic surgery led to significant reductions in opioid use at discharge, without resulting in greater pain intensity and side effects.Design: This retrospective pre-/post-intervention study evaluated patients before and after implementation of a pharmacist-led opioid de-escalation service.Setting: A major tertiary institution.Participants: Ninety eight participants underwent de-escalation, and 98 controls received standard care following orthopedic surgery.Intervention: Pharmacist-led opioid de-escalation was initiated after discharge from the institution's Acute Pain Service.Main outcome measure: Primary outcome was total morphine oral equivalence (MOE) required in the 24-hours before discharge between the two groups. Secondary outcomes included pain intensity scores and opioid-related side effects. Results: The post-intervention group used significantly less opioids in the 24 hours preceding discharge compared with the precohort (total MOE 30 vs 45 mg; p = 0.025).There were no differences in pain intensity at rest (p = 0.19) or with movement (p = 0.19). Cases experienced significantly less constipation (29 vs 49 percent; p = 0.004); no differences were observed for other side effects.Discussion: We observed statistically similar pain intensity ratings, in the setting of significantly lowered opioid doses among the post-intervention group prior to discharge.Conclusion: Pharmacist-led inpatient opioid de-escalation is effective, does not increase pain intensity, and reduces constipation. Hospitals should explore the viability of extending pharmacist-led opioid de-escalation to other surgical patients and following hospital discharge, aiming for opioid cessation.

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The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis

Current Diabetes Reviews ◽

10.2174/1573399816999201103141726 ◽

2020 ◽

Vol 16 ◽

Author(s):

Diala Alawneh ◽

Moustafa Younis ◽

Majdi S. Hamarshi

Keyword(s):

Diabetic Ketoacidosis ◽

Best Practice ◽

Intervention Group ◽

Post Intervention ◽

Management Algorithm ◽

Significant Difference ◽

Before And After ◽

Practice Advisory ◽

The Impact ◽

Post Intervention Group

Background: According to the Center for Disease Control and Prevention, diabetic ketoacidosis (DKA) hospitalization rates have been steadily increasing. Due to the increasing incidence and the economic impact associated with its morbidity and treatment, effective management is key. We aimed to streamline the management of DKA in our intensive care units (ICU) by implementing a Best-Practice Advisory (BPA) that notifies providers when DKA has resolved. Methods: A BPA was implemented on 9/15/2018. We conducted a retrospective review of patients admitted to the ICU with DKA a year before and after 9/15/2018. Adults (≥18 age) meeting DKA criteria on admission and treated with continuous insulin infusion (CII) were included. Pre-intervention group included patients admitted before BPA implementation and post-intervention group included patients admitted after. Summary and univariate analyses were performed. Results: A total of 282 patients were included; 162 (57%) pre-intervention and 120 (43%) post-intervention. Mean (±SD) age was 44 (±17) years. There was no significant difference in baseline characteristics such as age, sex, race, BMI, HbA1c, initial blood glucose, anion gap or bicarbonate concentration between both groups (p>0.05). Mean (±SD) total time on CII in hours was significantly lower in the post-intervention group 14.8 (±7.7) vs 17.5 (±14.3) p=0.041, 95% CI: 0.11-5.3. The incidence of hypoglycemia was lower in the post-intervention group n=4 (3%) vs 17 (10%), p=0.024. There was no significant difference in hypokalemia, mortality, LOS or ICU stay between both groups (p>0.05). Conclusions: The BPA introduced in our DKA management algorithm successfully reduced total time on insulin and the incidence of hypoglycemia.

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Effects and Responsiveness of a Multicomponent Intervention on Body Composition, Physical Fitness and Leptin in Overweight/Obese Adolescents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18147267 ◽

2021 ◽

Vol 18 (14) ◽

pp. 7267

Author(s):

Leticia Borfe ◽

Caroline Brand ◽

Letícia Schneiders ◽

Jorge Mota ◽

Claudia Cavaglieri ◽

...

Keyword(s):

Body Composition ◽

Physical Fitness ◽

Intervention Group ◽

Interleukin 10 ◽

Control Group ◽

Post Intervention ◽

Necrosis Factor Alpha ◽

Obese Adolescents ◽

Quasi Experimental ◽

Multicomponent Program

Physical exercise reduces the biochemical markers of obesity, but the effects of multicomponent interventions on these markers should be explored. The present study aimed to elucidate how overweight/obese adolescents respond to a multicomponent program approach on body composition, physical fitness, and inflammatory markers, using a quasi-experimental study with 33 overweight/obesity adolescents (control group (CG) = 16; intervention group (IG) = 17). The intervention consisted of 24 weeks with physical exercises and nutritional and psychological guidance. Both groups were evaluated at the pre/post-intervention moments on body mass index (BMI); body fat (%Fat); waist circumference (WC); waist/hip ratio (WHR); waist-to-height ratio (WHtR), cardiorespiratory fitness (CRF); abdominal strength, flexibility; leptin; interleukin 6; interleukin 10; and tumor necrosis factor-alpha. Mixed-analysis of variance and generalized estimation equations were used for statistical analysis. There was an interaction effect between groups and time on %Fat (p = 0.002), WC (p = 0.023), WHR (p < 0.001), WHtR (p = 0.035), CRF (p = 0.050), and leptin (p = 0.026). Adolescents were classified as 82.4% responders for %Fat, 70.6% for WC, 88.2% for WHR, and 70.6% for CRF. Further, there was an association between changes in %Fat (p = 0.033), WC (p = 0.032), and WHR (p = 0.033) between responders and non-responders with CRF in the IG. There was a positive effect on body composition, physical fitness, and leptin. In addition, reductions in body composition parameters were explained by CRF improvements.

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87. Utilization of Methicillin-Sensitive/Resistant Staphylococcus aureus Nares Screen to Decrease Vancomycin and Linezolid Use in Hospitalized Patients with Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.132 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S60-S60

Author(s):

Noor F Zaidan ◽

Rachel S Britt ◽

David Reynoso ◽

R Scott Ferren

Keyword(s):

Staphylococcus Aureus ◽

Respiratory Infections ◽

Intervention Group ◽

Kidney Injury ◽

Post Intervention ◽

Gram Positive ◽

Stewardship Program ◽

Screening Protocol ◽

The Impact ◽

Post Intervention Group

Abstract Background Pharmacist-driven protocols for utilization of methicillin-resistant Staphylococcus aureus (MRSA) nares screenings have shown to decrease duration of empiric gram-positive therapy and rates of acute kidney injury (AKI) in patients with respiratory infections. This study evaluated the impact of a pharmacist-driven MRSA nares screening protocol on duration of vancomycin or linezolid therapy (DT) in respiratory infections. Methods Patients aged 18 years and older with a medication order of vancomycin or linezolid for respiratory indication(s) were included. The MRSA nares screening protocol went into effect in October 2019. The protocol allowed pharmacists to order an MRSA nares polymerase chain reaction (PCR) for included patients, while the Antimicrobial Stewardship Program (ASP) made therapeutic recommendations for de-escalation of empiric gram-positive coverage based on negative MRSA nares screenings, if clinically appropriate. Data for the pre-intervention group was collected retrospectively for the months of October 2018 to March 2019. The post-intervention group data was collected prospectively for the months of October 2019 to March 2020. Results Ninety-seven patients were evaluated within both the pre-intervention group (n = 50) and post-intervention group (n = 57). Outcomes for DT (38.2 hours vs. 30.9 hours, P = 0.601) and AKI (20% vs. 14%, P = 0.4105) were not different before and after protocol implementation. A subgroup analysis revealed a significant reduction in DT within the pre- and post-MRSA PCR groups (38.2 hours vs. 24.8 hours, P = 0.0065) when pharmacist recommendations for de-escalation were accepted. Conclusion A pharmacist-driven MRSA nares screening protocol did not affect the duration of gram-positive therapy for respiratory indications. However, there was a reduction in DT when pharmacist-driven recommendations were accepted. Disclosures All Authors: No reported disclosures

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1346. Implementation of a Multidisciplinary 48 Hour Antibiotic Timeout in a Pediatric Population

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1528 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S684-S684

Author(s):

Victoria Konold ◽

Palak Bhagat ◽

Jennifer Pisano ◽

Natasha N Pettit ◽

Anish Choksi ◽

...

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Intervention Group ◽

Post Intervention ◽

Days Of Therapy ◽

New Antibiotics ◽

Core Elements ◽

Quasi Experimental ◽

Empirical Antibiotics ◽

The Impact

Abstract Background To meet the core elements required for antimicrobial stewardship programs, our institution implemented a pharmacy-led antibiotic timeout (ATO) process in 2017 and a multidisciplinary ATO process in 2019. An antibiotic timeout is a discussion and review of the need for ongoing empirical antibiotics 2-4 days after initiation. This study sought to evaluate both the multidisciplinary ATO and the pharmacy-led ATO in a pediatric population, compare the impact of each intervention on antibiotic days of therapy (DOT) to a pre-intervention group without an ATO, and to then compare the impact of the pharmacy-led ATO versus multidisciplinary ATO on antibiotic days of therapy (DOT). Methods This was a retrospective, pre-post, quasi-experimental study of pediatric patients comparing antibiotic DOT prior to ATO implementation (pre-ATO), during the pharmacy-led ATO (pharm-ATO), and during the multidisciplinary ATO (multi-ATO). The pre-ATO group was a patient sample from February-September 2016, prior to the initiation of a formal ATO. The pharmacy-led ATO was implemented from February-September 2018. This was followed by a multidisciplinary ATO led by pediatric residents and nurses from February-September 2019. Both the pharm-ATO and the multi-ATO were implemented as an active non-interruptive alert added to the electronic health record patient list. This alert triggered when new antibiotics had been administered to the patient for 48 hours, at which time, the responsible clinician would discuss the antibiotic and document their decision via the alert workspace. Pediatric patients receiving IV or PO antibiotics administered for at least 48 hours were included. The primary outcome was DOT. Secondary outcomes included length of stay (LOS) and mortality. Results 1284 unique antibiotic orders (n= 572 patients) were reviewed in the pre-ATO group, 868 (n= 323 patients) in the pharm-ATO and 949 (n= 305 patients) in the multi-ATO groups. Average DOT was not significantly different pre vs post intervention for either methodology (Table 1). Mortality was similar between groups, but LOS was longer for both intervention groups (Table 1). Impact of an ATO on DOT, Mortality and LOS Conclusion An ATO had no impact on average antibiotic DOT in a pediatric population, regardless of the ATO methodology. Disclosures All Authors: No reported disclosures

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110. Impact of Diagnostic and Antimicrobial Stewardship on Time-to-Appropriate Therapy and Clinical Outcomes in Multi-Drug Resistant Pseudomonas Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.155 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S69-S70

Author(s):

Katie A McCrink ◽

Kailynn DeRonde ◽

Adriana Jimenez ◽

Gemma Rosello ◽

Yoichiro Natori ◽

...

Keyword(s):

Clinical Outcomes ◽

Antimicrobial Stewardship ◽

Patient Survival ◽

Intervention Group ◽

Culture Collection ◽

Drug Resistant ◽

Intervention Period ◽

Post Intervention ◽

Appropriate Therapy ◽

Post Intervention Group

Abstract Background Timely effective therapy in multi-drug resistant (MDR) Pseudomonas (PsA) infections has a direct impact on patient survival. We aimed to determine the impact of diagnostic and antimicrobial stewardship (AMS) on time-to-appropriate therapy (TAP) and clinical outcomes of patients with MDR PsA infections utilizing novel beta-lactam/beta-lactamase inhibitors (BL/BLIs). Methods Retrospective cohort study of adult patients with MDR PsA infections at a 1,500-bed University-affiliated public hospital in Miami, Florida who received ≥72 hours of ceftazidime-avibactam (C/A) or ceftolozane-tazobactam (C/T). During the pre-intervention period (12/2017-12/2018), additional susceptibilities for C/A and C/T were performed upon providers’ request. In the post intervention period (01/2019 – 12/2019), we implemented automatic reflex algorithms (Figure 1) for faster identification and susceptibilities for MDR PsA, including carbapenemase producers. Results were communicated in real-time to the AMS team. Figure 1. Reflex Testing Algorithm for MDR Pseudomonas Isolates from Any Source Results Seventy-six patients were included; median age was 56 years (IQR 37.5–67.0), 40 (52.6%) were in an intensive care unit at time of culture collection; median APACHE II score was 20 (IQR 15.0 – 26.0). Three isolates were carbapenemase producers (VIM = 2; KPC = 1). The most common infections were pneumonia (56.6%) and bacteremia (18.4%). We found a significant decrease in median TAP (120.1 [IQR 82.5–164.6] vs 75.9 [IQR 51.3–101.7] hours, p = 0.003). Median time from culture collection to final susceptibility results was shorter in the post-intervention group (122.2 vs 90.5 hours; p < 0.001). Median length-of-stay after culture collection was numerically lower in the post-intervention group (26.0 [11.6–59.4] vs 19.7 [12.9–37.8] days; p = 0.33). Controlling for ICU admission, our intervention was not associated with decreased 30-day inpatient mortality (OR = 1.62, 95% CI 0.45–5.79). Conclusion Our study identified an improvement in TAP in MDR PsA infections with implementation of diagnostic and AMS initiatives. In an adequately powered study, our intervention could potentially impact patient survival through timely initiation of effective therapy with novel BL/BLIs. Disclosures All Authors: No reported disclosures

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600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.794 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S362-S363

Author(s):

Gaurav Agnihotri ◽

Alan E Gross ◽

Minji Seok ◽

Cheng Yu Yen ◽

Farah Khan ◽

...

Keyword(s):

Hospital Readmission ◽

Multinomial Logistic Regression ◽

Univariate Analysis ◽

Tertiary Care ◽

Intervention Group ◽

Care Hospital ◽

Full Time ◽

Post Intervention ◽

Before And After ◽

The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

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