Category: Professional Posters
Purpose: Outpatient parenteral antimicrobial therapy (OPAT) allows for patients to be discharged from the hospital while still receiving intravenous therapy for their infections. Oftentimes, patients are seen by the inpatient infectious diseases (ID) team and enrolled in OPAT in advance of their discharge. Enrollment may take place anywhere from several days to several weeks before actual discharge, and patients’ clinical condition may change in the interim. The purpose of this study was to describe the impact of a dedicated pharmacy resident on an OPAT rotation on the antimicrobial regimens of OPAT-enrolled inpatients.
Methods: Two pharmacy residents spent 4 weeks each on OPAT rotations (4/23/18 to 5/11/18 and 3/11/19 to 4/12/19). The rotation consisted of reviewing charts of patients who were enrolled in OPAT but not yet discharged, speaking with and orienting patients to the OPAT program, communicating any interventions with the primary and ID teams, documenting their interventions, and entering pharmacy consult notes in the online medical record. Residents were on rotation Monday through Friday. Resident interventions and consult notes were reviewed and data compiled, using descriptive statistics to summarize findings. This retrospective medical record review received exempt approval from the institutional review board.
Results: Since initiation in 2015, approximately 3300 patients have been enrolled in the OPAT program. During the resident rotation time period, 109 patients were enrolled in OPAT and eligible for study inclusion. Of those, 77 patients (70.6%) were reviewed by the residents. Most patients were male (57%), with a mean age of 62.6 years (standard deviation 16.9). The most common infectious indications for OPAT were osteomyelitis (29.0%), bacteremia (28.0%), and abscess (10.8%). Most patients (55.8%) were discharged on one antimicrobial agent, although 33.8% were discharged on two agents and 10.4% were discharged on three agents. The most common antimicrobial OPAT regimens included vancomycin (28.6%), ceftriaxone (20.6%), cefazolin (20.8%), daptomycin (14.3%), metronidazole (11.7%), cefepime (7.8%), and meropenem (7.8%). The residents performed a total of 85 patient visits (range 0-5 visits per patient). Sixty-three interventions were recommended, with 50 (79.3%) accepted by the team(s). The most common interventions included dosing recommendations (23.8%), coordination of care (20.6%), antibiotic choice (12.7%), monitoring (12.7%), and duration of therapy (7.9%). Fifty-five interventions involved medications, with the most common being intravenous vancomycin (25.5%), daptomycin (21.8%), ceftriaxone (10.9%), cefazolin (9.1%), and metronidazole (7.3%).
Conclusion: Establishing a pharmacy resident rotation on an OPAT service resulted in a high number of interventions identified and accepted by the primary team(s). The interval between OPAT enrollment and patient discharge presents opportunity to maximize antimicrobial stewardship principles.