620. Identifying the Role for a Pharmacist on an Outpatient Parenteral Antimicrobial Therapy (OPAT) Team in an Academic Teaching Hospital

Background Outpatient parenteral antimicrobial therapy (OPAT) is currently an emerging practice to continue effective treatment after hospital discharge for patients requiring parenteral (IV) treatment. Pharmacists can collaborate with outpatient services like home infusion services to allow for safe administration and monitoring of IV antibiotics. The role of pharmacists in an OPAT team has been shown to improve patient outcomes such as optimizing antimicrobial therapy and reducing hospital length of stay and readmissions. We sought to define the utility of an OPAT pharmacist at an academic teaching hospital that currently does not have an OPAT service. Methods Patients receiving IV therapy via home infusion from 1/4/21 to 3/4/21 were screened for inclusion and excluded if antimicrobials were not prescribed. Infection characteristics and antimicrobial therapy were recorded. Interventions on day of and after discharge were noted. Duration of therapy (DOT) was calculated by the difference between start and stop dates of appropriate antibiotics. Discharge delays due to OPAT-related reasons were recorded. Continuous data are expressed as median (IQR). Categorical data are expressed as frequencies (%). Results Of the patients screened, 77 of 123 patients met inclusion criteria. Most patients were treated for a bone/joint infection (29/77, 38%). Ceftriaxone (18/82, 22%) and vancomycin (13/82, 16%) were the most frequently prescribed agents. The median DOT was 30 days (IQR 15, 42). On day of discharge, 52 opportunities for a pharmacist initiated intervention were identified with majority being clarifying DOT (19/52, 37%), streamlining or escalating antibiotic (8/52, 15%), and optimizing drug dose (8/52, 15%). OPAT-related discharge delays resulted in an excess of 58 hospital days and over 25% of patients (20/77) were readmitted 30 days after discharge. The most common post-discharge issues (n=56) were worsening infection (11/56, 20%), PICC line issues (9/56, 16%), and drug related adverse events (8/56, 14%). Conclusion A pharmacist on a dedicated OPAT service can assist with antimicrobial selection, treatment duration, and drug monitoring to promote patient safety in patients discharged on antimicrobials. Disclosures All Authors: No reported disclosures

605. Rates of Patient Satisfaction with Home-Based Outpatient Antimicrobial Therapy (OPAT)

Background The use of home-based outpatient parenteral antimicrobial therapy (OPAT) is well established. Studies by the National Home Infusion Foundation (NHIF) show that 1.4 million patients receive OPAT each year.1 With patient satisfaction a priority, NHIF developed, validated, and reliability tested the Uniform Patient Satisfaction Survey for Home Infusion Providers in 2017.2 Medicare patients are the fasting growing segment in the US and account for a disproportionate share of health care usage. Determining older patient satisfaction is imperative because patients who are more satisfied are more compliant with treatment3 and tend to return for continued care.4 Accordingly, the purpose of this study was to determine the level of home-based OPAT patient satisfaction and if a significant difference (p = ≤ .05) exists between the 0-64 and 65+ age groups. Methods 2019 and 2020 OPAT survey data (n=5,559) was used in this study. Top box percent, typically used in health care patient satisfaction, was calculated for each survey question. Data was summarized using 7 composite categories formed from the 22 survey questions. Differences (p = ≤ .05) between the age groups was also calculated. Results Mean patient age was 64.31 (SD=14.78), 54.99% were 65+ years old, and 58.85% were male. OPAT patients gave high marks to their home infusion service (Table 1). The highest top box % for the composite scores was “Patient instructions” which averaged 98.91%. The most common healthcare satisfaction question “I was satisfied with the overall quality of the services provided” showed significant difference between the age groups (p = .002) with the 0-64 groups being more satisfied than the 65+ (Exhibit 1). Table 1. OPAT Patient Satisfaction Survey Composite Scores: Percent of Patients Selecting Top-Box Score (n= 5,559) Exhibit 1. Level (%) of Agreement to “I was satisfied with the overall quality of the services provided” by Age Group (n = 5,559) Conclusion Analysis of each survey question shows the 65+ patients are less satisfied than younger patients on the following: being informed of side effects, explanation of financial responsibilities, and the helpfulness of the billing staff. Even though the scores are high for both age groups, additional research needs to be conducted to determine why scores for the 65+ age group are lower, and changes needed for improvement. Knowing the level of OPAT patient satisfaction will benefit infectious disease physicians, providers, prescribers, payers, and regulators as they evaluate how to expand home-based services. Disclosures All Authors: No reported disclosures

Barriers to patient-centered oncology care: Pilot study of home infusion of anticancer immunotherapy.

36 Background: ASCO published a position statement regarding home infusion of anticancer therapy in June 2020. This statement recommends independent research to evaluate the safety and effectiveness of home infusions. Intermountain Healthcare (IM) incorporated this statement into its oncology care with an IRB-approved, prospective single-arm pilot study to determine the safety and feasibility of home administration of checkpoint inhibitor (CPI) immunotherapy with synchronous telemedicine visits. Methods: Patients with cancer receiving treatment at Intermountain Medical Center and Intermountain Cancer Center St. George were screened for enrollment into an IRB-approved, non-randomized pilot study of 20 patients. Eligibility criteria required patients to receive a CPI for an FDA-approved indication, live in Washington County or Salt Lake County, Utah, and have commercial payer coverage of CPI home infusion. Eligible patients were required to receive 2 doses of CPI at an infusion center, and patients who experienced an infusion reaction were excluded from receiving home infusion. Home infusion nurses are trained in oncology, CPIs, and home infusion reaction protocol. During synchronous video visits, infusion nurses are trained to perform the hands-on portions of the physical exam. A financial analysis estimated cost to IM and commercial payers for routine and home CPI infusions. Results: 622 patients were screened, of which 104 were receiving a CPI. 64 patients lived in an eligible county and 19 patients had commercial payer coverage. Of patients on CPIs, 8.7% (9/104) met all eligibility criteria accounting for 1.4% (9/622) of all patients with cancer screened (Table). Financial analysis estimated $829 cost (excluding drug cost) to IM for standard infusion reimbursement compared to $599 for in-home CPI infusions, accounting for savings of $230 per infusion. Majority of cost savings are from elimination of infusion center facilities fee ($495). Analysis includes $269 for home infusion nurse wages. Subsequent analysis for commercial payer SelectHealth estimates $270 reimbursement savings for the payer. Conclusions: Home immunotherapy infusions are estimated to be cost effective for both IM and commercial payers. However, lack of drug coverage and the rural demographics of Utahns with cancer are barriers to home CPI infusions. The pilot study was discontinued per infeasibility stopping criteria.[Table: see text]

591. A Model for assessing staffing needs for an Outpatient Parenteral Antibiotic Therapy (OPAT) program

Background Management of patients needing OPAT is complex, and requires a multidisciplinary team for transitioning patients from inpatient to outpatient care, ongoing monitoring of labs, antibiotic levels, managing complications of the drugs and intravenous access, and communicating with patients, family, home infusion pharmacies, home care nursing agencies, and the patients’ physicians and other providers. In addition, documentation of each of these activities in the EMR is necessary. Guidance on how to determine number of staff needed for an OPAT program is lacking. Methods We created a detailed step by step list of the various activities done by our OPAT nurse (RN) and determined the time needed to perform each activity. We calculated how many hours of nursing time would be needed per week to perform all the activities for patient care based on our OPAT volume. Results In 2019 we enrolled 767 patients in 835 episodes of OPAT. Our weekly census averages about 120–135 patients. Median duration on OPAT was 30 days. We calculated that our OPAT RN workload was an average of 47.5 hours/week (range of 40–55 hours/week), with time per activity ranging from 5 minutes to 3 hours (table). As this calculated to more than one full time RN position, additional staff were requested. Assessment of Staffing Requirements for an OPAT Program Conclusion We have assessed the workload for OPAT RN(s) in our program based on our 2019 patient volume. We recommend that one RN can safely manage about 500–550 patients per year. Based on this analysis we were successfully able to justify the need for a second RN for our program. Any OPAT Program can do such analysis to determine their OPAT staffing needs, and also plan for the anticipated increases in OPAT volume because of increasing longevity of the population, increase in diabetes incidence, invasive procedures such as arthroplasties, cardiac devices, etc. Limitations This analysis does not include time spent by inpatient staff to arrange for home care and home infusion services. It also does not account for an ID pharmacist time, or the physicians and APP time for management of these patients outside of the billable visit. Disclosures All Authors: No reported disclosures

202. Implementation of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Collaborative for Patients with Staphylococcus aureus or Gram-Negative Bacilli Bacteremia Requiring Home Infusion: The PANTHIR Program

Background Staphylococcus aureus (SA) and Gram-negative bacilli (GNB) bacteremia often require prolonged treatment courses due to high morbidity and mortality risk. Outpatient parenteral antibiotic therapy (OPAT) has emerged as a preferred delivery method. Few data have been published regarding the follow-up and adverse event rates among OPAT patients. We describe outcomes in patients with SA or GNB bacteremia transitioning from an academic medical center to home infusion, prompting the implementation of the Parenteral ANtimicrobial therapy Transitions to Home Infusion Review (PANTHIR) program. Methods A retrospective chart review of adult patients with SA or GNB bacteremia at the University of Minnesota Medical Center requiring home infusion represent a 26-month period. Baseline outcomes, including 30-day hospital readmissions and adverse drug events (ADEs), were calculated. The PANTHIR program was launched as an interdisciplinary collaborative with an infectious diseases (ID) provider, pharmacists, and home infusion specialists. Core program elements include inpatient identification, ID pharmacist review, care plan documentation and communication, and OPAT program measures. Results The retrospective cohort included 69 patients. 23.2% experienced a hospitalization within 30 days of discharge and 26.1% experienced an ADE (Table 1). The mean duration of therapy was 22 days. No patient received aminoglycosides and one required vancomycin. A primary goal was to improve the continuity of care for potentially life-threatening bacteremia during the vulnerable inpatient to outpatient transition. Electronic health record functionality allowed for creation of an OPAT navigator for infectious diseases (ID) pharmacist transition plan documentation, electronic communication with designated provider and home infusion pharmacist, and retrieval of focal data points for ongoing program evaluation. 28 patients have been enrolled in the PANTHIR program with outcomes data collection underway. Table 1. Retrospective data among University of Minnesota Medical Center patients hospitalized with SA or GNB bacteremia requiring home infusion on discharge. Conclusion Hospital readmission rates and ADEs are frequent among patients with SA or GNB bacteremia requiring OPAT via home infusion. An ID pharmacist-directed program in collaboration with an ID provider is feasible for OPAT transitions and may serve as a roadmap for other institutions. Disclosures Dana Simonson, PharmD, BCPS, Janssen (Advisor or Review Panel member, Other Financial or Material Support, Webinar Series Speaker Fall 2019)